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LIBRARY OF CONGRESS. 

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UNITED STATES OF AMERICA. 



0. 



IN PREPARATION. 

TREATMENT OF DISEASES 

PECULIAR TO 

WOMEN, 

PUERPERAL and NON-PUERPERAL 



This valuable work will be presented on a similar 
plan to Children's Diseases and Heart and 
Lungs, and will contain the latest and most approved 
methods of treatment of all the diseases peculiar to 
women, puerperal and non-puerperal ; based upon 
the recent practical investigations and experiences of 
the leading physicians and specialists, and in the 
hospitals, of New York City. 



TREATMENT OF DISEASES 

OF 



INFANCY 



AND 



CHILDHOOD, 



WITH OVER 

Four Hundred Formulae and Prescriptions, 

As Exemplified in the Services of 

Drs. A. Jacobi, J. Lewis Smith, Alonzo Clark, Austin Flint, W. A. Ham- 
mond, A. L. Loomis, W. H. Thomson, J. H. Ripley, T. Gaillard 
Thomas, J. R. Leaming, F. Delafield, L. A. Sayre, C. R. 
Agnew, L. Duncan Bulkley, Beverly Robinson, R. 
W. Taylor, G. H. Fox, F. N. Otis, A. A. Smith, 
E. C. Seguin, F. A. Burrall, E. G. 
Janeway, F. H. Bosworth, A. H. 
Smith, C. E. Billington, 
G. M. Lefferts, 

ETC., ETC., 

And in the Hospitals of New York City. 



J BY 

CHARLES H. GOODWIN, M. D. 

" 




IXl^H-0 



NEW YORK : 

C. H. GOODWIN, M.D., 

245 West 5 3D Street. 

1883. 









c* 



Copyright. 

By CHARLES H. GOODWIN, M.D. 

A. D. 1883. 






PREFACE 



In this volume the author has essayed to give a 
thoroughly practical, and at the same time concise, 
resume of the treatment of the various diseases incident 
to childhood. His apology for the work must rest upon 
the very large number of requests from subscribers to 
the previous volume on Treatment of Heart and Lung 
Diseases. 

From the numerous investigations that have recently 
been made in infantile diseases, and the light that has 
been thrown upon them, great improvement has 
developed in the methods of treatment. It is these 
recent and morS advanced practical therapeutical views 
of the several leading medical authorities of New York 
City, and which in their experiences are the most 
approved and the most successful, that the author has 
endeavored to place before the general practitioner, 
fully and in the minutest detail and yet with the most 
careful discrimination. 

Among medical publications the author knows of none 
similar in character to this, and it is earnestly hoped 
that the work will prove a useful one to the profession. 



CONTENTS 



PART I. 



GENERAL DISEASES. 



Anemia 9 

Treatment by Dr. A. Jacobi, (9); by Dr. W. A. Hammond, 
(13); by Dr. T. Gaillard Thomas, (13); by Dr. J. Lewis 
Smith, (14); by Dr. A. H. Smith, (17); by Dr. Alonzo 
Clark, (17); by Dr. Beverly Robinson, (18). 

Rachitis ig 

Treatment by Dr. A. Jacobi, (19); by Dr. W. H. Thomson, 

(23). 

SCROFULOSIS ,24 

Treatment by Dr. J. Lewis Smith, (24); by Dr. A. Jacobi, 
(26); by Dr. F. N. Otis, (26). 

Acute Rheumatism 27 

Treatment by Dr. W. H. Draper, (27); at New York Hos- 
pital, (30); by Dr. A- Jacobi, (30); by Dr. J. H. Ripley, 
(30); by Dr. Alonzo Clark, (30); by Dr. W. H. Thomson, 
(31); by Dr. Austin Flint, (31); at Hart's Island Hospital, 
(33); at Bellevue Hospital, (33); at Roosevelt Hospital, (34); 
at Charity Hospital, (34). 

Syphilis 35 

Treatment by Dr. J. Lewis Smith, (35); by Dr. F. N. Otis, 
36); at Charity Hospital, (37); by Dr. R. W. Taylor, (37); 
by Dr. G.H. Fox, (38); at Bellevue Hospital, (40); by Dr. 
W. H. Draper, (40); at New York Hospital, (41); at 
Roosevelt Hospital, (41). 



PART II. 

diseases of the air-passages. 

Diphtheria 42 

Treatment by Dr. J. Lewis Smith, (42); by Dr. A. Jacobi, 
(45); by Dr. C. Billington, (51); by Dr. A. A. Smith, (54); 
by Dr. F. Delafield, (54); by Dr. Beverly Robinson, (55); by 
Dr. J. H. Ripley, (56); by Dr. Alonzo Clark, (56); by Dr. 
L. Elsberg, (56); by Dr. J. R. Learning, (56); by Dr. E. 
C.Wendt, (57); the Alcohol or "Brooklyn," treatment, 
(57). 



IV CONTENTS. 

CORYZA 60 

Treatment by Dr. J. Lewis Smith, (60); by Dr. A. A. 
Smith, (62); by Dr. J. R. Learning, (63). 

True Croup (Acute Croupous Laryngitis) 63 

Treatment by Dr. J. H. Ripley, (63); by Dr. J. R. Learn- 
ing. (67); hyDr. J. Lewis Smith, (68); by Dr. F. Delafield, 
(69); by Dr. A. Hadden, (70); by Dr. A. L. Loomis, (73); 
by Dr. Austin Flint, (74). 

Spurious or Catarrhal Croup (Acute Catarrhal Laryngitis.) 74 
Treatment by Dr. J. Lewis Smith, (74); by Dr. F. Delafield, 
(75); by Dr. A. L. Loomis, (76). 

Laryngismus Stridulus (Spasmodic Croup) 78 

Treatment by Dr. J. Lewis Smith, (78); by Dr. A. L. Loomis, 
(79); by Dr. W. H. Thomson, (79); by Dr. A. A. Smith, 
(79); by Dr. F. Delafield. (80). 

Hooping Cough , 81 

Treatment by Dr. J. Lewis Smith, (81); by Dr. A. Jacobi, 
(82); by Dr. J. R. Learning, (82); by Dr. H. S. Dessau, (82); 
by Dr. A. L. Loomis, (83); at Beilevue Hospital, (83); at 
the Infants' Hospital, (84). 

Epistaxis 84 

Treatment by Dr. A. Jacobi, (S4); by Dr. G. M. Lefferts, 
(85); by Dr. W. H. Draper, (85); by Dr. Alonzo Clark, (85). 



PART III. 

diseases of the digestive organs. 

Stomatitis 87 

Treatment by Dr. J. Lewis Smith, (87) ; by Dr. J. H. Ripley, 
(88); at the Nursery and Child's Hospital, (89). 

Tonsillitis 90 

Treatment by Dr. A. Jacobi, (90); by Dr. J. R. Learning, 
(91); by Dr. F. Delafield, (91); by Dr. F. H. Bosworth, (93); 
by Dr. W. H. Draper, (93); at New York Hospital, (93); 
by Dr. F. A. Burrall, (94); by Dr. G. M. Lefferts, (94); by 
Dr. Beverly Robinson, (97); by Dr. F. H. Hamilton, (97). 

Pharyngitis 98 

Treatment by Dr. A. Jacobi, (98); by Dr. A. H. Smith, 
(100); by Dr. F. H. Bosworth, (100); by Dr. A. A. Smith, 
(101); by Dr. F. Delafield, (101); by Dr. G. M. Lefferts, 
(102). 

Vomiting — Dyspepsia 102 

Treatment by Dr. J. Lewis Smith, (102); at the Infants' 
Hospital, (103); by Dr. A. H. Smith, (103); by Dr. A. A. 
Smith, (104); by Dr. W, A. Hammond, (105); by Dr. F. 
Delafield, (106). 



CONTEXTS. V 

Gastritis 106 

Treatment by Dr. F. Delafield, (106). 
Enteralgia (Colic) — Enteritis 10S 

Treatment by Dr. J. W. McLane, (108); by Dr. F. A. 

Bunall, (ioS); by Dr. Austin Flint, (log); by Dr. A. A. 
Smith, (109): by Dr. F. H. Hamilton, (109); at the Infants' 
Hospital, (no); at New York Hospital, (no); by Dr. F. 
Delafield, (in). 

DlARRHCEA 112 

Treatment by Dr. J. Lewis Smith, (112); by Dr. E. G. 
Janeway, (113); by Dr. A. A. Smith, (114); by Dr. F. Dela- 
field, (115); at the Infants' Hospital, (116); at Hart's 
Island Hospital, (116); at Bellevue Hospital, (117). 

Intestinal Catarrh nS 

Treatment by Dr. A. Jacobi, (11S); by Dr. J. Lewis Smith, 
(121); by Dr. F. Delafield, (122); by Dr. A. A. Smith, (125); 
at Bellevue Hospital, (126). 

Dysentery 126 

Treatment by Dr. F. Delafield, (126); by Dr. J. Lewis 
Smith, (12S); by Dr. G. B. Fowler, (129); by Dr. Alonzo 
Clark, (129); at Bellevue Hospital, (130). 

Cholera Infantum (Spurious Hydrocephalus) 130 

Treatment by Dr. J. Lewis Smith, (130); at New York 
Foundling Asylum, (131); by Dr. F. Delafield, (133). 

Constipation 134 

Treatment by Dr. A. Jacobi, (134); by Dr. A. A. Smith, 
(137). 

Worms 137 

Treatment by Dr. J. Lewis Smith, (137); by Dr. A. Jacobi, 
(13S); by Dr. Yan Giesen, (139). 

Incontinence of Urine 140 

Treatment at Bellevue Hospital, (140). 

Infantile Leucorrhcea 141 

Treatment by Dr. T. Gaillard Thomas, (141); by Dr. J. B. 
Hunter, (142); by Dr. V. P. Gibney, (143); by Dr. Beverly 
Robinson, (143); at New York Hospital, (143). 



PART IV. 



diseases of the brain and nervous system. 

Convulsions 14. 

Treatment by Dr. J. Lewis Smith, (144); by Dr. A. Jacobi, 
(146); by Dr. A. A. Smith, (147); by Dr. E. C. Seguin, (152). 



VI CONTENTS. 

Chorea.. , 153 

Treatment by Dr. J. Lewis Smith, (153); by Dr. A. Jacobi, 
(154); by Dr. W. A. Hammond, (155); by Dr. E. C. Seguin, 
(156); by Dr. W. H. Thomson, (157); by Dr. E. G. Jane- 
way, (157); at New York Hospital, (158). 

Epilepsy 158 

Treatment by Dr. W. A. Hammond, (,158); by Dr. J. 
Lewis Smith, (163); by Dr. E. C. Seguin, (163). 

Infantile Paralysis 167 

Treatment by Dr. A. Jacobi, (167); by Dr. F. Delafield, 
(169) ; by Dr. W. A. Hammond, (169) ; by Dr. E. C. 
Seguin, (170); at Bellevue Hospital, (173); at Charity Hos- 
pital, (173). 

Acute Meningitis 173 

Treatment by Dr. F. Delafield, (173); by Dr. E. C. Seguin, 
(175); by Dr. W. A. Hammond, (175). 

Acute Hydrocephalus (Tubercular Meningitis) 176 

Treatment by Dr. F. Delafield, (176); by Dr. J. Lewis 
Smith, (177). 

Spurious Hydrocephalus — See Cholera Infantum. 

Chronic Hydrocephalus 17S 

Treatment by Dr. F. Delafield, (178); by Dr. E. C. Seguin, 
(178). 

Cerebro-Spinal Meningitis 179 

Treatment by Dr. F. Delafield, (179); by Dr. J. Lewis 
Smith, (181); by Dr. F. A. Burrall, (182); by Dr. W. H. 
Draper, (183). 

Spina Bifida 184 

Treatment by Dr. L. A. Sayre, (184); by Dr. A. Jacobi, (185); 
by Dr. H. B. Sands, (185); by Lister, (185). 



PART V. 

FEVERS. 

Typhoid Fever 186 

Treatment by Dr. W. H. Draper, ^186); by Dr. Beverly 
Robinson, (192); by Dr. F. Delafield, (193); by Dr. W. H. 
Thomson, (194); by Dr. A. H. Smith, (195); by Dr. Austin 
Flint, (196) ; at Bellevue Hospital, (196) ; by Dr. A. L. 
Loomis, (198). 

Scarlet Fever 20s 

Treatment by Dr. Alonzo Clark, (202); by Dr. J. Lewis 
Smith, (204); by Dr. A. L. Loomis, (205); by Dr. G. M. 
•Lefferts, (207) ; by Dr. F. A. Burrall, (207) ; by Dr. D. 



CONTENTS. Vll 

Lewis, (207); by Dr. A. Jacobi, (209); by Dr. J. H. Rip- 
ley, (210). 
Measles 216 

Treatment by Dr. Alonzo Clark, (216); by* Dr. A. L. 

Loomis, (217). 
Variola (Small Pox) 219 

Treatment by Dr. J. N. McChesney, (219); by Dr. Alonzo 

Clark, (225); by Dr. A. L. Loomis, (227); by Dr. \V. H. 

Thomson, (223). 
Intermittent Fever 228 

Treatment by Dr. Austin Flint, (228) by Dr. Alonzo Clark, 

(229); by Dr. F. A. Burrall, (230) ; by Dr. J. C. Peters, 

(231); at New York Hospital, (231); by Dr. A. L. Loomis, 

(232); at Bellevue Hospital, (234). 
Typhus Fever 235 

Treatment by Dr. Austin Flint, (235) ; by Dr. A. L. 

Loomis, (23S). 
Otitis (Ear-Ache) 241 

Treatment by Dr. O. D. Pomeroy, (241); by Dr. A. Jacobi, 

(243); by Dr. R. F. Weir, (244); by Dr. A. A. Smith, (244); 

by Dr. Beverly Robinson, (244); by Dr. C. R. Agnew, (244); 

by Dr. S. Sexton, (245). 
Ophthalmia 248 

Treatment by Dr. C. R. Agnew, (248) ; by Dr. J. Lewis 

Smith, (250). 



PART VI. 

SKIN diseases. 

Eczema 251 

Treatment by Dr. L. Duncan Bulkley, (251); by Dr. A. 
Jacobi, (258); at Bellevue Hospital, (259); by Dr. G. H. 
Fox, (259); by Dr. W. H. Draper, (263); by Dr. R. W. 
Taylor, (264); at New York Hospital, (264). 

Herpes 265 

Treatment by Dr. G. H. Fox, (265); by Dr. W. H. Draper, 
(266). 

Erysipelas 267 

Treatment by Dr. A. Jacobi, (267); by Dr. V. P. Gibney, 
(268); at Bellevue Hospital, (268); at Presbyterian Hospital, 
(268). 

Erythema 269 

Treatment by Dr. L. D. Bulkley, (269); by Dr. G. H. Fox, 

(270). 



Vlll CONTENTS. 

Urticaria 270 

Treatment by Dr. L. D. Bulkley, (270); by Dr. G. H. Fox, 

(271); by Dr. A. A. Smith, (271). 
Scabies (Itch) 272 

Treatment by Dr. W. H. Draper, (272); by Dr. G. H. Fox, 

(273); by Dr. L. D. Bulkley, (273); at Bellevue Hospital, 

(274). 
Phthiriasis (Lousiness) 274 

Treatment by Dr. G. Ff. Fox, (274). 
Tinea Favosa (Favus) 276 

.Treatment by Dr. L. D. Bulkley, (276). 
Tinea Tonsurans (Ringworm) 278 

Treatment by Dr. G. H. Fox, (278); at Bellevue Hospital, 

(278). 
Alopecia Areata (Tinea Decalvans) 279 

Treatment by Dr. G. H. Fox, (279). 
Psoriasis 281 

Treatment by Dr. G. H. Fox, (281). 
Pityriasis 282 

Treatment by Dr. G. H. Fox, (282). 
Purpura Hemorrhagica) (Morbus Maculosus) 283 

Treatment by Dr. A. Jacobi, (283). 



PART I. 
GENERAL DISEASES 



ANEMIA. 

Dr. A. JacOBI believes the occurrence of anaemia 
in infancy and childhood, to be a circumstance of vital 
importance. He, moreover, directs especial atten- 
tion to the fact, that although this condition is so 
frequently observed and so dangerous, and one which 
ought to be treated of by the best of practitioners 
and writers, yet there is no text-book in which a 
comprehensive study of the subject can be found. 

In all cases, he advises that plenty of out-door 
exercise be taken, and if necessary this should be 
enforced. Crowded school-rooms, and excessive les- 
sons, should be particularly avoided. Regarding the 
diet, irregular and fast eating is prohibited as bad 
habits. For infants, he directs that, in the main, 
solid food be withheld. Barley-water and cow's 
milk, in his opinion, will make far better muscle than 
poor mother's milk. Cow's milk, either undiluted or 



10 ANEMIA. 

diluted with water only, is also prohibited. The 
same restrictions are insisted upon regarding con- 
densed milk. In fact, Dr. JACOBI advises that no 
milk whatever should be used, without the addition 
of some gelatinous or farinaceous decoction, such as 
barley-water, etc. ; and particularly in anaemia beef- 
soup should be added. At the end of the first year 
solid food may be given, and such articles be gradu- 
ally included in the diet as physiology and experience 
permits. 

Regarding the use of remedial agents, he finds that 
although iron has long been resorted to in the treat- 
ment of anaemia and chlorosis, yet a great many 
children recover in consequence of the change of 
diet, together with rest and an improved general 
nutrition, and without the use of any iron what- 
ever. Besides, he frequently meets with cases 
in which the administration of iron is abso- 
lutely unavailing. In using this remedy, how- 
ever, the preparations which, in his experience, 
are most beneficial, are the lactate, the tincture 
of the pomate, the pyrophosphate, the subcar- 
bonate, and the tincture of the chloride, or muri- 
ated tincture. They should not, however, be given 
in the inflammatory fevers, although they may be in 
the septic type. Where, in addition, an absorbent 
is indicated, as in slow convalescence after inflam- 



ANEMIA. I I 

mations resulting in exudation, and especially in 
diseases of the glands and lungs, the syrup of the 
iodide is used, thus : 

5 • Sy rupi ferri iodid. . . gtt.x. 

Aquae ..... q. s. 

M. Sig. Dose, thrice daily, to a child of two years. 

The iodide, he advises, meets two indications, and, 

moreover, the iodine is set free in the stomach and 

interferes with decomposition. When gastric catarrh 

is present and hinders the general improvement in 

progressive anaemia, or during slow convalescence, he 

finds the following combination especially beneficial : 

E. Ferri subcarbon. 

Bismuth, subcarbon. 
Sodii bicarb. . . gr. xvi-xxx. 

M.*Sig. This amount daily, to a child of two years. 

When the action of the heart is lowered and the 
blood-pressure diminished. Dr. Jacobi gives the 
tincture of the chloride (being a vascular irritant » 
with greatest sen-ice. In cases of anaemia associated 
with gastric catarrh, and catarrh of the upper portion 
of the small intestine, he considers the pyrophosphate 
the more desirable preparation. He also uses the 
hypophosphites and the phosphates with good results. 
In chronic anaemia he finds they are all valuable. In 
these chronic cases, also, and especially where there 



12 ANAEMIA. 

is a peculiar torpid condition of the stomach, much 
benefit is frequently derived by him from the admin- 
istration of arsenic, in minute doses, daily, well 
diluted with water ; he gives it thus : 

5- Liq. potass, arsenit. . . . m. i-ii. 

Aquae q. s. 

M. Sig. Dose, after meals. 

Or, he often prescribes it with iron, and with or 
without stomachics. By this means, he finds that 
marked results obtain from improving the general 
nutrition, and this is particularly so in cases where 
there is also nervous trouble. He has also found 
strychnia sulphate, in doses of gr. T V daily, to a child 
of two years, very serviceable as an adjuvant to 
either arsenic or iron, its use being continued for a 
long period of time, combined with proper food. In 
some instances phosphorus is employed by him with 
much benefit, and in cases associated with caries, 
etc., he often obtains very favorable results. The 
following is the formula for the tincture of phos- 
phorus used at BELLEVUE HOSPITAL: 

1$. Phosphori . . . . gr. xxxii. 

Alcohol, absol. . . . gxlvi. 

Tinct. vanillse . . . . § i. 

01. aurant. cort. ... 3 iii- 

Alcohol. absol. q. s. ad . 5 xlviii. 



ANAEMIA. 13 

* M. Sig. Twenty minims contain gr. ^ of phos- 
phorus. 

Concerning the benefit derived from the use of 
cod liver oil, Dr. Jacobi finds that although fre- 
quently of great service, yet in his experience the 
contra-indications are often overlooked. Most chil- 
dren, he advises, do not bear it well in the summer 
time, and some not at all. In all cases, moreover, he 
cautions that whenever digestion is impaired, and 
gastric catarrh present, preliminary treatment is 
required before the administration of either cod 
liver oil or iron. 

The following is Dr. W. A. HAMMOND'S mixture : 
9- Ferri pyrophosphat. . . . 3 i. 

Quiniae sulph 3 i. 

Strychniae . . . . gr. i. 

Acid, phosphor, dil. . . 3 ii. 

Syrup, zingib § ii. 

• Aquae ad .... g iv. 

M. Dose : A teaspoonful or less, according to age. 
Dr. T. GAILLARD THOMAS prescribes the follow- 
ing with excellent effect for the anaemia of chlorosis, 

* The phosphorus is digested with absolute alcohol, with 
exclusion of air, until dissolved ; then the flavoring ingredients 
are added, and finally the bulk is made up with absolute alcohol 
to fl. ? xlviii. 



14 ANEMIA. 

occurring in young girls at about the age of puberty: 

9- Ferri vini amari . . . § viiss. 

Tinct. nucis vomicae . . . 3 iv. 

Liq. potass, arsenit. . . . 3 ii. 

M. Sig. A dessertspoonful in a glassful of water, 
just after each meal. 

In addition to this, Dr. THOMAS, regarding the 
indications as being to remove the cause, cure the 
neurosis, and repair the damages, advises general 
tonic treatment and the observance of good hygiene. 

Dr. J. LEWIS SMITH aims to improve and build 
up the general health of the child by the administra- 
tion of the ferruginous and vegetable tonics, and by 
suitable hygienic measures. The following is one of 
Dr. Smith's favorite tonic formulas : 

5. Ferri et ammon. cit. 

Ammon. carbon. . . aa gr. xxxii. 
Syrupi ...... 

Aquae anisi ■ . . . . aa§ii. 

M. Sig. A teaspoonful. 

In cases of anaemic neuralgia occurring in chil- 
dren of from eight to twelve years — neuralgia de- 
pendent upon and associated with anaemia — and 
which he finds is due chiefly to a condition of debil- 
ity, he places the child upon a most nutritious diet, 
consisting largely of milk and beef, and directs that 



ANEMIA. • 1 5 

it be kept away from school for a season, as the 
study and strict discipline exacted, together with the 
necessary confinement and long hours, always aggra- 
vate this malady. He also advises that plenty of 
out-door exercise be taken, and residence in the 
country secured if possible ; together with regularity 
in the meals, the full amount of sleep, and the avoid- 
ance of constipation. 

As regards medicinal measures, he orders a moder- 
ate amount of alcoholic stimulant, as a teaspoonful of 
brandy in milk, taken at meals, with considerable 
satisfaction. In addition to this, his treatment con- 
sists in the administration of any of the vegetable 
bitters with iron. The following combination is a 
favorite with him in these cases, and from its use 
he has often obtained marked and usually prompt 
benefit ; this formula is also very extensively used 
at Bellevue Hospital : 

5- Ferri et potass, tart. . . . 3i. 
Tinct. cinchonae co. . . . § iv. 

M. Sig. A teaspoonful in a little water, four times 
daily. 

In some instances, under this treatment, the head- 
ache, even of months standing, has ceased in less 
than two weeks. 

Dr. Smith also derives much good from stint- 



1 6 ANAEMIA. 

ulating and irritating applications along the spine. 
When the pain is in the trunk, he never employs a 
lengthened blister, or any blister over the spine, as 
recommended by some, but usually prefers a stimu- 
lating application, as an ammoniacal mixture ; or 
the following is much relied upon by him for this 
purpose : 

^. Olei terebinthinae .... 

Linim. saponis camphorat. . . e. p. 
M. Sig. To be applied with brisk friction, several 
times daily. 

Or he frequently obtains considerable temporary 
relief from the use of dry cups, applied in three or 
four places over the spine, and along its side oppo- 
site the seat of pain. But for permanent good, he 
places the greatest reliance upon constitutional 
remedies. 

In some instances, he advises, there is also more 
or less palpitation, and frequently anaemic heart mur- 
murs are heard ; or sometimes an occasional ^hort 
and painless cough, without expectoration, is present. 
In such cases, he has found the following prescrip- 
tion of most valuable service : 

^. Ferri sulphat 3 ss. 

Acid nitric. . . . . fl. 3 ss. 

Aquae destill. . . . § ss. 



ANEMIA. 17 

M. Sig. Four drops, four times daily, in sweet- 
ened water. 

This cough, he finds, may also be relieved by the 
use of belladonna and the bromides, but at the same 
time advises that iron, tonics, and careful attention to 
hygiene, must constitute the chief means of treat- 
ment. 

In anaemic girls at the age of puberty, and es- 
pecially if chlorotic, Dr. A. H. Smith prescribes the 
following tonic mixture, from the use of which he 
has obtained the most gratifying results : 

9- Hydrarg. chlorid. corros. . . gr. i-ii. 
Liq. arsenici chloridi . . . fl. 3 i. 
Tinct. ferri chloridi 
Acid, hydrochlor. dil. . aa fl. 3 iv. 

Syrupi fl. § iii. 

Aquae ad fl. § vi. 

M. Sig. One to two teaspoonfuls in a wineglass- 
ful of water, after each meal. 

This should not, however, be continued for more 
than two weeks at a time. 

Dr. Alonzo Clark varies his treatment some- 
what according to the associated condition. Besides 
the use of constitutional remedies, where there is 
also anorexia, nausea and vomiting, and constipa- 
tion, he causes a free movement of the bowels, and 



1 8 ANEMIA. 

directs that they be kept in an active condition. He 
then endeavors to aid digestion and to improve the 
general health by the administration of medicinal 
remedies, such as pepsin and nitro-muriatic acid, 
together with good, nutritious food, and by the 
maintenance of good hygiene. If head symptoms 
are present, these, he finds, also disappear as the 
patient improves. 

Dr. Beverly Robinson prescribes the following 
with great satisfaction, in those cases of progressive 
pernicious anaemia occurring in young girls at or 
about the time of puberty : 

9- Ext. cascarae sagradae fl. . 3 ss. 

Aquae § ss. 

M. Sig. Dose, at bedtime. 

This is also to be repeated in the morning if re- 
quired. In conjunction with the above he then 
administers : 

5. Pil. ferri carbon. (Vallet) . No. x. 

Sig. One three times daily, with meals. 

Under this treatment benefit has followed in a 
very short time. 



RACHITIS. 19 

RACHITIS. 



In treating these cases in infants, Dr. A. JACOBI 
first advises keeping the child in as uniform a tem- 
perature as possible, not allowing the room to get 
too hot, but maintaining an even temperature of 
about 70 , with a slight degree of moisture in the air 
by means of steam. An abundance of fresh air is 
also secured through proper ventilation ; this, he 
finds, is worthy of the highest consideration, and its 
importance cannot be over-estimated. He further 
directs that the child be bathed regularly and at 
more frequent intervals than usual, at least every 
morning and night. For this purpose the cold water 
bath, with perhaps a little salt in it, is used, and the 
child warmly clothed afterward. 

Where a baby of one year is still at the breast, as 
is often the case, he insists that it be weaned at 
once, as the rachitis is probably more or less de- 
pendent upon the character of the mother's milk. 
In doing this, farinaceous foods, such as barley and 
oat-meal mixed with boiled cow's-milk, are gradually 
substituted for the breast-milk. He advises discrim- 
ination, however, in the use of barley and oat-meal, 
according to the condition of the bowels. If the 
bowels incline to be constipated, oat-meal is pre- 
ferred ; but where diarrhoea is present, barley is used 



20 RACHITIS. 

because of its tendency to constipation. Besides 
these, beef-tea or soup are also added to the diet. 
In older children, that is to say, of two or three 
years of age, he directs that plenty of beef and eggs 
be given in addition ; but where the general ill- 
nutrition is very marked, with a flabby condition of 
the muscles, and constipation, Dr. JACOBI places the 
child on a diet consisting of a few teaspoonfuls of 
raw meat and one egg in the twenty-four hours, 
together with plenty of oat-meal with cow's-milk. 
Moreover, too much milk, he advises, may prove in- 
jurious by forming a superabundance of lactic acid 
in the stomach and intestines. 

Regarding direct treatment, it is questionable with 
him whether any is necessary, in a great many cases. 
He does not generally care to give much medicine 
directly, provided he can harden and toughen the 
child by cold water bathing and proper food. When 
there is much cough present, opium is occasionally 
required. As a rule, however, and especially where 
there is more or less glandular enlargement, he gives 
the iodides, preferring the following as one of the 
best preparations : 

]pfc. Syrupi ferri iodidi . . gtt. viii-x. 
Aquae . . . . . . q. s. 

M. Sig. Dose, three times daily. 

In addition the salts of sodium and calcium are 



RACHITIS. 21 

usually given in fair quantity. In many cases he 
also combines the above with cod liver oil, in doses of 
3 i, three times daily. The following emulsion is 
very much used at Bellevue Hospital : 

5- Olei morrhuae 

Aquae calcis . . . aafl. § viii. 

Olei cinnamomi . . . gtt. x. 
M. 

In cases where the child is also subject to the fre- 
quent occurrence of convulsions, or even with symp- 
toms of meningitis present, Dr. JacOBI considers it 
vastly more important to improve the general con- 
dition, to insure good hygiene, fresh air, and nourish- 
ing food, than to treat the convulsions, which are 
but manifestations of the constitutional condition. 
In these children, he often finds that if plenty of 
oxygen, in the shape of fresh air, is obtained, the 
convulsions cease of themselves without any medici- 
nal resort. This abundance of air, he advises, must 
also be secured during the night, as well as the day, 
by means of proper and thorough ventilation. 

Under this plan of treatment the results, in his 
experience, have been very favorable. And even in 
cases where there is softening of the costal ends of 
the ribs, with a tendency to fractures of the bones 
of the arms, leg, and thigh — or rather infractures — 



22 RACHITIS. 

he finds this general anti-rachitic treatment very 
beneficial. The fractures heal and general improve- 
ment in the condition of the child takes place. Later 
on, when the health is greatly improved, he remedies 
whatever defect may have taken place in the union 
of the bones, by refracturing them and permitting 
them to unite in a better position. Before this 
period, however, he often observes that all that is 
necessary is to bend the bones back again and retain 
them in their normal position. 

In the treatment of all cases, moreover, caution is 
advised in distinguishing between rachitis due to 
syphilis, and those which are not ; as in the latter 
mercurials would never be employed, while in the 
former they are necessary to the cure. 

In treating the seqaelce of rachitis, found in older 
children, where the pigeon breast, etc., is prominent, 
Dr. JacOBI's main object is to expand the lungs 
and to change the shape of the chest. Even where 
the disease is of long standing, he advises that it is 
possible, though not very probable, that the adminis- 
tration of potassium iodide will assist somewhat in 
causing a resolution of the induration in the lungs, 
which is not infrequently present. Where, however, 
the lung tissues have undergone constant changes, 
he thinks it will prove of little value. But since 
similar conditions are sometimes benefited by this 



RACHITIS. 23 

remedy, he recommends that it be, at least, tried in 
these cases ; it will also act beneficially on the 
chronic bronchitis, which is often a troublesome 
feature. In administering the drug, he sometimes 
gives it in combination with the iodide of iron, for a 
time, with great benefit. The following method is 
much used at BELLEVUE HOSPITAL : 

9- Potassii iodidi . . . 3iv. 

Syrupi ferri iodidi . . . 5 i. 

Tinct. calumbse q. s. ad. . § iv. 

M. Sig. Half- to a teaspoonful. 
Dr. JACOBI also directs that a good, nourishing 
and mixed diet be administered, such as beef, eggs, 
milk, farina, oatmeal, etc.; but coffee, tea, and 
stimulants are strictly prohibited. Open air exercise, 
play out of doors, gymnastics, the use of dumb-bells, 
etc., are also required, together with cold bathing; 
and during the winter cod liver oil should be taken 
to increase nutrition. 

The following is the formula for the emulsion of 
cod-liver oil used at ROOSEVELT HOSPITAL : 
5- Olei morrhuae . . . . 3 ii- 

Spts. lavandulae co. 

Spts. vini gall aa 3 i. 

M. 

Dr. W. H. Thomson finds that the best time to 



24 SCROFULOSIS. 

give cod-liver oil, when regarded as a food, is about 
one and one-half hours after a meal, as then the 
stomach is acting rapidly, and the oil is passed 
directly into the duodenum, where it can be readily 
emulsified by the pancreatic and intestinal juices. 



SCROFULOSIS. 



Of all the remedies employed in the treatment of 
the strumous diathesis of young children, Dr. J. 
Lewis Smith believes that the oxide of iron is ap- 
parently the best. This he gives in doses of gtt. i. 
for each year in the age of the child. In many 
cases of marked strumous aspect, he gives the fol- 
lowing with great benefit : 

IpL Syrupi ferri iodidi . . . gtt. iii. 
Aquae q. s. 

M. Sig. Dose, thrice daily, to a child of one year. 

In conjunction with this he also administers cod- 
liver oil. Where from the presence of an inflamed 
condition of the nostrils, fissures of the lips, etc., the 
suspicion exists that a syphilitic cachexia lies at the 
bottom of the case, he resorts to the application of 
the mercurial ointment, as follows : 



SCROFULOSIS. 25 

9. Pulv. zinci oxidi . . . 3i. 

Ung. hydrarg. nitrat. . . 3 ii- 

Oleo-paraffini (Vaseline) . . § i. 
M. Sig. To be applied four or five times daily. 
If stomatitis is also present, he makes use of the 
following with much satisfaction : 

9. Potass, chlorat. . . . 3 i. 

Tinct. ferri chlor 3 i. 

Glycerinae . . . . § ss. 

Aquae . . . . . . 3 ss. 

M. Sig. A teaspoonful every three hours. 
In cases of scrofulous glandular enlargements, and 
particularly where there is also much itching present, 
Dr. SMITH finds the following ointment very effica- 
cious : 

9 • Ung. hydrarg. nitratis . . 3 ii. 

Pulv. zinci oxidi . . . 3 ii. 

Acid, carbol. . . . . gr. xiv. 

Oleo-paraffini (Vaseline) . . § iss. 

M. Sig. Apply by inunction. 

The carbolic acid, he advises, is usually of excellent 
service in allaying the itching in these cases. Or, 
in certain instances, he uses iodine with good effect 
on the adenitis, thus : 

9. Sol. iodinii co 

Glycerinae . . . . aa§i. 

M. Sig. To be applied by inunction. 



26 SCROFULOSIS. 

Dr. A. Jacobi advises that in cases of strumous 
abscesses about the neck, after opening the abscess 
and evacuating its contents, he finds it an excellent 
plan to keep the opening patent by means of lint 
soaked in a two per cent, solution of carbolic acid. 

Dr. F. N. Otis obtains very marked benefit, in 
scrofulous children, from the administration of iodine 
in combination with Stewart's syrup. The method 
he uses, and which he considers to be a most valu- 
able prescription, is thus formulated : 

9- Iodinii gr. xxiv. 

Potass, iodidi . . . . 3 i- 

Aquae destill. . . . . § n • 

Solve et add. 

Stewart's syrup . . . . § vi. 

M. Sig. A dessert- to a tablespoonful three or four 
times daily. 

He has been accustomed to giving this to these 
children for many years, and in quantities that one 
would hardly suppose would be borne ; and which, 
he moreover believes, would certainly not be, if the 
iodine were given in any other form. 



ACUTE RHEUMATISM. 27 



ACUTE RHEUMATISM. 



Dr. W. H. Draper advises that the patient 
should be made as comfortable as possible in bed, 
and absolute rest secured. Rest he considers one of 
the most important therapeutic measures, and be- 
lieves that no detail in this direction is too small 
for the personal attention of the physician. It puts 
the circulation in the best possible condition, and 
helps to avoid complications. He therefore resorts 
to every necessary means to obtain rest and sleep, 
freedom from mental and emotional changes, to alle- 
viate the pain, and to relieve the suffering. Position 
he also considers an important factor in the treat- 
ment. The position of the affected limbs is made 
restful, and most comfortable for the patient. To 
accomplish this he finds it a good plan to put the 
joints up in splints, or pillows are used for supports, 
if necessary ; this not only saves a good deal of suf- 
ering, but lessens the amount of anodynes needed. 
Where the pain is too severe opium is given, in 
whatever form is most agreeable. This he finds is a 
very valuable aid in the treatment, and advises that 
the benefit gained thereby should never be denied 
the patient. 



28 ACUTE RHEUMATISM. 

The diet is another prominent feature which, in his 
opinion, should receive the most careful considera- 
tion. This, he advises, should be controlled in every 
case, both in acute and chronic disease, for by at- 
tending to the diet the recurrence of the malady may 
be prevented. The patient should, therefore, not be 
over-fed. The food is made simple, consisting of 
milk, which he considers best, together with animal 
broths, but no starches and sugars, and little bread. 
Gruels and farinaceous slops are believed by him to 
be the source of much mischief. All the water 
needed is allowed and, in many instances, mineral 
water is given, which he finds very beneficial. 

Regarding medication, Dr. Draper calls attention 
to the great variety of drugs which have gained a 
reputation as curative in this affection, due to the 
variation in the duration of the disease. As a rule, 
however, he finds that all cases will yield to the 
salicylic acid treatment, which is preferred by him. 
This he administers as follows : 

]pL Acid, salicylic. . . . gr. x. 

Sig. Dose, every two or^three hours, to a child of 
ten years. 

Under this treatment the tenderness, pain, and 
discomfort usually disappear, the fever subsides, and 
the patient enters upon convalescence often within 
twenty-four hours, or in periods varying from one to 



ACUTE RHEUMATISM. 29 

three or four days. In his experience the salicylate 
treatment of acute rheumatic fever is, as a rule, uni- 
formly successful, and no drug is shown to be so ser- 
viceable ; it actually cuts short the attack, and so 
long as the patient is under its influence improve- 
ment continues. He cautions, however, that the 
tendency to relapse should always be borne in mind, 
in using this treatment, and even after recovery has 
apparently taken place, the patient is kept at rest 
and the administration of the drug continued, in 
diminished doses, for a period of one or two weeks ; 
otherwise a relapse will almost invariably occur. 

Regarding complications, a great deal, he believes, 
can be done to prevent them by careful attention to 
treatment, by good nursing, and by a proper and 
judicious diet. They should, however, be constantly 
watched for, and the patient never visited without 
examining for endocardial affection. 

Concerning the use of blisters, in certain cases Dr. 
DRAPER applies a blister to the joint with much 
benefit ; but he advises that this should not be re- 
sorted to in acute attacks, where there is much swell- 
ing and fever. For, at the best, he finds that local 
irritation is not of much value, but from being em- 
ployed by some in these acute attacks, an erroneous 
opinion is, he believes, formed of its merits. In sub- 
acute forms, however, where there is a moderate de- 



30 ACUTE. RHEUMATISM. 

gree of synovial inflammation and moderate thicken- 
ing about the joint, the value of blistering is found 
to be greatly enhanced, and excellent results are 
often obtained by him from their application. The 
following is used as an anti-rheumatic at the New 
York Hospital: 



1$. Potass, iodidi 



3v. 



Vini colchici sem. . . § i. 

Tinct. cimicifugae rac. . § ii. 

Tinct. stramon § ss. 

Tinct. opii camphor. . . . § iss. 
M. 

Dr. A. Jacobi places the child upon the adminis- 
tration of salicylate of soda, with very satisfactory 
results. The pain, fever, and other symptoms dis- 
appear, and convalescence is established often in 
a very short time. 

Dr. J. H. Ripley prescribes the salicylic acid 
treatment as follows : 

9. Acid, salicylici . . . 3 ii- 

Sodii bicarbon. ... 3 iss. 

Aquae ad . . . § iv. 

M. Sig. A dessertspoonful every two or three 
hours. 

Dr. Alonzo Clark sometimes uses the alkaline 
treatment, or in many cases he administers the 



ACUTE RHEUMATISM. 31 

salicylate of soda, in doses of gr. viii.-x. every two or 
three hours during the first day, and the same amount 
at longer intervals on the second day. Under this 
treatment he usually succeeds in controlling the dis- 
ease in periods varying from one to three or four 
days, and in many instances within a few 
hours. Where much disturbance of the stomach re- 
sults from its use, he gives the drug by injection with 
equal benefit. In all cases, however, he considers'it 
of the highest importance to make daily examination 
of the heart. The cardiac disease, he finds, usually 
follows the articular trouble on about the fifth day ; 
hence he advises the importance of obtaining an 
early control over the rheumatic affection, and thus, 
if possible, prevent the heart lesion. 

DR. W. H. THOMSON prefers the following plan of 
administering the salicylate treatment, which is, 
moreover, a favorite prescription with him : 

9. Sol. acidi salicylici . . . §ii. 

Tinct. gaultheriae . .' . 3 i- 

Aquae ad § iv. 

M. 

Dr. Austin Flint prescribes the salicylate treat- 
ment, using either the acid or the soda salt. In the 
treatment of acute rheumatism with' salicylic acid, 
however, he advises that although the administra- 



32 ACUTE RHEUMATISM. 

tion of this drug occasionally causes the disease to 
abort, or, at least,* shortens its duration, yet it should 
not supersede the alkaline treatment, nor should the 
alkaline treatment be relinquished. This latter he 
carries to its full extent, as usual, since although it 
does not exert a marked effect on the duration of 
the disease, yet it diminishes the liability to pericar- 
ditis and endocarditis, which has not been shown for 
salicylic acid. In fact, he finds that since the use of 
the salicylate treatment, cardiac affections have be- 
come more common than before. This he considers 
to be of the highest practical importance. There- 
fore, when giving this drug he also .combines the al- 
kalies with it, in sufficient quantity to render the 
urine alkaline as speedily as possible; thus : 

9- Mist. acid, salicylici (gr. xlv-gi) . § ii. 
Sodii bicarbon. . . . . 3 ii. 

M. 

And if this is done at the commencement of the 
rheumatic attack, he believes that heart trouble 
would in a great many instances be prevented. Rest 
and quiet are also important points in his treat- 
ment. 

Moreover, while Dr. Flint places great reliance 
on the salicylate treatment, he has also used the ben- 
zoate of soda (as recommended by German authori- 



ACUTE RHEUMATISM. 33 

ties) experimentally in this disease. His results, 
however, go to show that although this agent does 
exert a certain amount of influence on the course of 
the malady, yet its effect is not to be compared to 
that attending the administration of salicylic acid or 
salicylate of soda. 

At the Hart's Island Hospital (for children) 
the following anti-rheumatic mixture is extensively 
used ; 

I£. Potass, iodidi . . . . 3 i. 

Potass, acetat. ... § iv. 

Tinct. colchici sem. . . . 5 ii. 

Aquae ..... Oii. 
M. Dose : A teaspoonful. 

At BELLEVUE HOSPITAL salicylic acid is very gen- 
erally employed, and with excellent results. In some 
cases delirium is caused by its administration, partic- 
ularly where a liberal exhibition of the drug has been 
made ; this quickly subsides, however, when the ex- 
citing cause is removed, or under the use of opiates 
or the bromides. In hearty, robust children of from 
nine to twelve years of age, the patient is put to bed 
and salicylic acid gr. x. every three hours administered; 
giving the following solution which, in many instan- 
ces, is found to agree better with the stomach and is 
much used, especially in children : 



34 ACUTE RHEUMATISM. 

IjL Acid, salicylici . . . 5 ss. 

Sodii bicarbon. . ■ . . q.s. 

Syrupi zingib. . . . . J ii. 

Aquae ad . . • . 5 vi. 

M. Sig. J ss. contains gr. xx. 

Should delirium occur after a few doses have been 
taken, the administration is stopped and the follow- 
ing given instead : 

]pfc. Potassii bromid. . . . gr.x. 
Aquae q.s. 

M. Sig: Dose. 

This may be repeated a few times until the delir- 
ium ceases. 

The salicylate treatment is also employed at 
Roosevelt Hospital, the method being formu- 
lated thus : 

9-. Acidi salicylici . . . gr.clx. 

Sodii bicarb 

Potass, bicarb. . . . aa 3 ii. 

Syrupi limonis . . . . | i. 

Aquae ad .... § iv. 

M. Sig. A dessertspoonful to a child of ten years. 

At Charity Hospital the following anti-rheu- 
matic mixture is prescribed : 





SYPHILIS. 




9. 


Sodii et potass, tart. 


5ss. 




Vini colchici sem. 


. 3H. 




Aquae q.s. ad 


S'ii. 


M. 


Dose : A teaspoonful. 





35 



SYPHILIS. 



In the treatment of syphilis, mercury in some form 
or other is the very generally accepted remedy. The 
method of administration, however, is principally the 
variation in treatment with different practitioners. 

Dr. J. Lewis Smith, in many instances, prefers 
the bichloride, and uses the following with very sat- 
isfactory results : 

9--- Hydrarg. bichlorid. . . . gr.ss. 
Potass, iodidi .... 

Ferri et ammon. cit. . . aa3i. 

Syrupi ^vl. 

M. Sig. A teaspoonful three times daily, to a 
child three to five years old. 

Or, where the general health is poor, the follow-; 
ing prescription is found by him to be of marked 
benefit : 



36 SYPHILIS. 

9- Hydrarg. bichlorid. . . gr.i- 

Syrupi sarsaparil. co. . . 3 

Aquae . . . , . 5 vl 

M. Sig. A teaspoonful three times a day. 

Dr. F. N. Otis gives mercury in small doses until 
a little impression is manifest ; he then diminishes the 
amount for a time until this effect has disappeared, 
when the administration is again renewed. In giving 
the drug he uses blue mass in a great majority of 
cases. In syphilis where there are scrofulous enlarge- 
ments, he advises that it is best to leave off the mer- 
curial treatment at as early a period as possible. 
After continuing it for some time, if the evidences of 
syphilis have passed entirely away and no new symp- 
toms present themselves, he generally omits the mer- 
cury and gives some milder preparation in connec- 
tion with potassium iodide. In these scrofulous 
cases Dr. Otis is in the habit of using iodine very 
freely, instead of the iodide of potassium, and finds 
it not only equally effective, but these constitu- 
tions are also braced up and benefited by it. In 
giving it he uses Stewart's syrup, which, in his ex- 
perience, is superior to any other vehicle. He has 
prescribed this for many years and finds it an exceed- 
ingly valuable preparation ; the formula employed 
by him for this purpose is as follows : 



SYPHILIS. 37 

]J. Iodinii ..... gr.xxiv. 
Potass, iodid. . . . . 3 i. 

Aquae destill. . . . § ii. 

Solve et add. 

Stewart's syrup . . . . § vi. 
M. Sig. A dessert- to a tablespoonful three or 
four times daily. 

By this combination he is able to give iodine in 
very large quantity and for a long time, without any 
distaste and without disturbing the stomach. 

The above plan of treatment Dr. Otis considers 
particularly valuable in cases of syphilis where there 
is also scrofula. 

At Charity Hospital the following mixture is 
very considerably used : 

5- Potass, iodid 3 iv. 

Syrup, sarsap. co. 

Tinct. gent. co. . . aa J i. 

M. 

Dr. R.W. Taylor has made the subject of infantile 
syphilis his especial study, and, in his experience, 
the following formula and method of administration 
are of the greatest efficacy : 

9- Hydrarg. bichlorid. . . . gr. i. 
Potass, iodidi . . . . 3 iv. 

Syrup, aurantii 
Aquae . • . . . aa 3 ii- 



38 SYPHILIS. 

M. Sig. Five drops, for a child about two months 
old. 

This amount he then increases to gtt. xv-xx, if 
the disease does not yield. He advises, however, 
that it is important to suspend the medicine alto- 
gether, from time to time, as the system acquires a 
tolerance for it. 

Dr. G. H. Fox uses the bichloride of mercury in 
small doses very effectually, in cases of infantile 
syphilis. In tubercular forms, he often finds rapid 
improvement from the administration of potassium 
iodide internally, combined with the external applica- 
tion of mercurial ointment. Or, in older children and 
where the case is of long standing, with debility, loss 
of appetite, etc., he orders mercury and potassium 
iodide in compound syrup of sarsaparilla, to be taken 
internally, in conjunction with the local application. 
Should the latter cause too much irritation of the skin 
it is omitted, continuing the mixed treatment. 
Marked benefit usually follows. Frequently, how- 
ever, as improvement takes place the medicine 
causes nausea and sickness at the stomach • he then 
stops the mercury and administers : 

9- Potassii iodidi ... gr. ii-v. 

Aquae ..... q. s. 

M. Sig. To be taken three times daily. 



SYPHILIS. 39 

In regard to the use of mercury and other rem- 
edies in the treatment of syphilis, Dr. Fox main- 
tains that while it is a most valuable remedy, yet 
mercury is an overrated drug, and is not essential to 
the cure of the disease. He believes that it is best 
administered internally rather than by inunction, by 
vapor baths, or by hypodermic injectron. In his ex- 
perience, also, the amount usually given is unneces- 
sarily large, and its local irritant effects should be 
avoided. As regards the duration of its use, this 
should vary according to the severity of the case ; 
no absolute rule is advised. Iodide of potassium, he 
thinks, should not be reserved entirely for the later 
stage of the disease, for there is no period in which 
either iodine or mercury is not capable of doing 
good. Moreover, instead of the so-called " mixed 
treatment," he prefers to give the two agents separ- 
ately. Potassium iodide, he finds, ought not to be 
given continuously for any great length of time, as 
it acts quickly or not at all, and when unnecessarily 
continued is sure to do harm. Also, very large doses 
should not be administered without the strongest 
indications ; he believes they are of value in certain 
cases, but advises that iodism has often been mis- 
taken for the exhibition of syphilis. Iron is con- 
sidered by Dr. Fox as deserving to be ranked with 
mercury and iodide of potassium, from its effects on 



40 SYPHILIS. 

the anaemia that invariably accompanies the early 
stage. Cod liver oil is also a remedy which he finds 
of great value, especially where there is a strumous 
condition present. 

The following is found very serviceable at BELLE- 
vue Hospital : 

]J. Hydrarg. chlor. corros. . . gr. i. 
Potass, iodidi . . . . 3 ii- 

Tinct. gent. co. ... § iv. 

M. 

Dr. W. H. Draper obtains excellent results from 
the administration of constitutional treatment. In 
hereditary cases he advises the great importance of 
early diagnosis. The mild or the bi-chloride are often 
used, but he considers the protiodide as probably the 
best method of giving the drug, it being more active 
than the former preparation. If diarrhoea is pro- 
duced, opium may be added. He also calls atten- 
tion to the fact that although these patients can take 
mercury and iodine to an almost unlimited extent, 
yet the susceptibility varies considerably, which 
should constantly be borne in mind. When ad- 
ministration by the mouth is contraindicated or im-. 
practicable, he finds inunction the best method. An 
ointment of mercury rubbed up with fat is, in his 
experience, superior to the old form of ointment, 



SYPHILIS. 



41 



Sometimes tonics, quinia, etc., are also required ; 
but, as a rule, he considers that mercury in small 
doses acts as a tonic, lowering the temperature and 
supporting nutrition. In the fever accompanying 
the syphilitic cachexia, and which shows itself at 
times with headache, etc., Dr. Draper uses the 
specific treatment very effectually; the usual anti- 
pyretics, he advises, are useless, and alcohol only 
serves to make matters w r orse. 

The following combination is highly esteemed at 
the New York Hospital : 



9. Hydrarg. biniodid. 


gr. i. 


Potass, iodidi 


3v. 


Syr. aurant. cort. 


§". 


Tinct. cardam. co. 


. . . 311- 


Aquae q. s. ad. 


Siv. 



M. 

At Roosevelt Hospital the following mixed 
treatment is employed : 
9. Hydrarg. chlor. corros. 

Potass, iodidi .... 

Syrup, sarsap. co. 

Aquae . . . . . aa 3 ii. 

M. 



;r. 11. 

3vi. 



PART II. 

DISEASES OF THE AIR PASSAGES. 



DIPHTHERIA. 

Contrary to the opinion of many specialists in 
throat diseases, Dr. J. LEWIS SMITH considers diph- 
theria as primarily a constitutional disease. He 
believes that when the larynx is involved, the affec- 
tion can only be successfully treated by solvent in- 
halations, or, if they fail, by tracheotomy. As a rule, 
he directs that the child be placed in a small room 
which is filled with steam, and the croup kettle and 
steam atomizer set to work. For internal medica- 
tion he orders the following : 

Ijfc. Tinct. ferri chlor. 
• Potass, chlorat. . . . aa 3 n. 
Syrupi $ w - 

M. Sig. A teaspoonful every hour, to a child of 
five years. 



DIPHTHERIA. 43 

Or sometimes, in conjunction with the above, 
the following is also given : 

9.. Quiniae sulphat. . . . 3 ss. 

Elix. taraxaci . . . § ii. 

M. Sig. A teaspoonful every two to four hours. 

Locally, he considers lime very efficient, although 
in many cases the progress of the disease is too rapid 
for its action. From experiments made in the New 
York Foundling Asylum, he has found that a two per 
cent, mixture of liquor potassce (or liquor sodce) in 
water, is a more efficient solvent than any other 
agent which is commonly used ; and with this dilu- 
tion it does not cause smarting or irritation of the 
healthy buccal or faucial surface. It is, however, 
acrid and irritating in its nature, and may thus act 
upon those parts which are already inflamed. He 
therefore uses the following : 

Ijfc. Liquor potassae . . . 3 i. 

Aquae calcis .... 3 vii. 

M. Sig. To be used almost constantly, by the 
atomizer. • 

By this means the liquor potassae, being still further 
diluted by the steam from the boiler, reaches the 
faucial and laryngeal surfaces in the proportion of 
one to eighty-four. In some cases, he has used in-^ 
halations of lactic acid with acidulated liquid pepsin, 



44 DIPHTHERIA. 

but his results have not been favorable ; indeed, he 
does not find it so good a solvent as even the officinal 
lime water, and, moreover, the atomizer is apt to be- 
come corroded. 

Stimulants are also given. When diphtheria com- 
plicates scarlet fever, Dr. SMITH advises that more 
active stimulation is demanded than when the dis- 
ease is idiopathic. He usually gives brandy in doses 
of 3 i. every half hour, to a child of three years hav- 
ing these two infectious maladies. He has also, in 
many instances, employed the antiseptic treatment 
of scarlatina and diphtheria by Listerine. For this 
purpose, the following is a favorite with him, pre- 
scribed together with the old remedies : 

IjL Acid, carbol. ... m. viii. 

Liq. ferri subsulphat. . . 3 ii-iii. 

Glycerinae . . . 5 i. 

M. Sig. Apply to the throat with a camel's-hair 
pencil, two or three times a day. 

For paralysis of the uvula, which is a very fre- 
quent sequela of this disease in children, strychnia is his 
sheet-anchor. For administration, he prefers the 
following preparation, 3 i- of which contains gr. -^ of 
strychnia, and gives it thus : 

9- Elix. phosphat, ferri et strychniae 3 i- 

Aquae 3 iv. 

M. Sig. Dose, three times daily. 



DIPHTHERIA. 45 

Under this treatment, he finds that in the majority 
of instances the paralysis disappears in less than a 
week. 

DR. A. JACOBI advises that the strictest attention 
should be paid to even the minutest detail of treat- 
ment. He believes that in a large majority of »the 
cases of diphtheria which terminate fatally, death 
occurs because of mismanagement, particularly in the 
worst forms of the disease ; and where a case of 
nasal diphtheria dies, he considers it usually due to 
insufficient treatment or improper management. 
Since the adoption of cleansing and disinfecting in 
his plan of treatment, the results which he has ob- 
tained have greatly improved. He finds that often 
when there is a slight membrane, but with an enor- 
mous swelling of the glands below and behind the 
angles of the jaw, a sure indication of nasal diph- 
theria, showing that there is direct poisoning from 
that locality, if immediate resort is made to nasal in- 
jections every half hour, or every hour, marked im- 
provement follows, and he not infrequently succeeds 
in reducing the glandular swellings one-half in twelve 
hours. 

When the case is seen at the early stage with the 
tonsils enlarged and covered with spots of membrane, 
Dr. JACOBI often prescribes : 



46 DIPHTHERIA. 

9- Potass, chlorat. . . gr. ss-i. 

Tinct. ferri chlor. . . . gtt. v-x. 
Glycerinae .... 
Aquae . . . . aa q. s. ad 3 i- 

M. Sig. Dose, every twenty minutes, to a child 
of three to five years. 

In addition to this, if the glands commence 
to enlarge, ice is applied. He considers it im- 
portant that frequent local application should 
be made to the parts, and by giving the above 
mixture in this way (every twenty minutes), the in- 
fected tonsils are constantly washed with the potassa 
and iron. At night he directs that the medicine be 
given every hour ; this does not interfere with rest, as 
the child falls asleep almost immediately afterward. 

He, moreover, lays particular stress upon the fact 
that patients are left alone, often at dangerous periods 
of the disease, and especially cautions against per- 
mitting the child to sleep undisturbed, a constant 
tendency caused by the septic poisoning. Hence, in 
these dangerous cases, he considers it highly neces- 
sary to effect a cure in thirty-six or forty-eight hours, 
and advises that the child must not be allowed to 
sleep during the day or night, longer than intervals 
between the times of using the injections or medi- 
cines prescribed ; that is to say, for a period of fif- 



DIPHTHERIA. 47 

teen minutes or naif an hour. Children who do not 
give much trouble die, and it is these cases, he insists, 
that must be thus attended to. At first he uses the 
nasal injections every half hour for six or eight 
hours, and then every hour. In some, however, at 
the commencement he finds it necessary to inject the 
nose every half hour, and to continue this for twenty- 
four hours ; after which once an hour may be suffi- 
cient. Careful attention to these particulars, he ad- 
vises, will often result in favor of cure. 

Concerning the use of stimulants, Dr. Jacobi 
finds that it is in these septic cases that alcohol is 
especially indicated, but that the administration 
must not be trifled with ; from 5 vi-viii. to 3 x-xii. 
of brandy must be given in the twenty-four hours. 
In support of this plan he mentions a case in which 
diphtheria and scarlatina were combined. The child, 
in spite of moderate treatment, alcoholic and other, 
was sinking rapidly and almost given up ; but when 
stimulants in large amounts of § viii-x. were admin- 
istered, a rapid recovery followed. 

As to the value of lime water, his opinion of this 
agent is not so high as that of many writers. He 
believes there is very little or no efficacy in it, since 
in the amount used by the atomizer there is hardly a 
trace of lime ; and although the membrane is dis- 
solved by maceration in lime water for six or eight 



48 DIPHTHERIA. 

hours, yet he thinks this action can hardly be claim- 
ed for its momentary contact with the throat. 

Regarding the internal administration of potassium 
chlorate, he objects to the long continued and ex- 
tensive use of this drug, believing that when given 
in doses exceeding 3 i. in amount during twenty-four 
hours, to a child of less than three years of 
age, nephritis is almost certain to result. Where, 
however, catarrhal stomatitis is also present, he re- 
sorts to potassium chlorate in order that the sur- 
rounding tissues may be rendered healthy. Ben- 
zoate of sodium he considers as of little or no ser- 
vice. 

The following is, however, the method of admin- 
istration according to the Letzerich treatment : 

9- Sodii benzoat. pur. . . . 3 i. 
Aquae destill. .... 

Aquae menth. pip. . . . aa 3 i. 

Syrup, aurant. cort. . . . 3 ii. 

M. Sig. A dessertspoonful every hour, to a 
child under one year. 

His opinion of the utility of pilocarpine is also un- 
favorable, and in those cases in which the deposit is 
deeply imbedded in the lower structures, he believes 
it does positive harm, possibly hastening a fatal issue. 
If the drug be used at all he prefers the flmd extract. 



DIPHTHERIA. 49 

as the muriate of pilocarpine is decomposed in the 
stomach. « 

In regard to the removal of the membrane, so far 
as the tonsils are concerned, Dr. JACOBI objects to 
this interference ; in other situations, however, he 
removes the false membrane when possible to do so. 
But he cautions against resorting to this procedure 
injudiciously, and prefers to continue the injections 
and washings for a long time, rather than to attempt 
the removal of membrane which is not perfectly- 
loose. Finally, in all cases, he urges that careful at- 
tention to nourishment is of the greatest importance. 
He directs that the child be abundantly fed with the 
most nutritious diet, given largely every hour or two, 
in a liquid form ; and that life be sustained by stimu- 
lants and nourishment during the night in the same 
manner. By this means he believes some lives may 
be saved that would otherwise be lost. 

In the treatment of the sequela of diphtheria, Dr. 
Jacobi advises that the majority of cases of par- 
alysis run a benign course, and get well in eight or 
ten weeks. His treatment is in the main tonic and 
stimulant, feeding the child on beef, milk, and eggs, 
with alcohol in small quantities. As a tonic iron is pre- 
ferred, varying the preparation according to the case. 
If diarrhoea is present, he uses the sulphate of iron 
most beneficially. For a nervine he considers strych- 
4 



50 DIPHTHERIA. 

nia as most efficient and powerful in its effects, and 
gives it to the amount of gr. ^ daily, to a child of 
four years, beginning with strychjticBsulph.gr. ^ three 
twies a day. When the paralysis is extending, and 
fear is entertained that the respiratory muscles may 
become involved, he resorts to the galvanic and far a- 
dic currents, principally the latter, and administers 
hypodermic injections of strychniae in doses of gr. -fa 
once or twice, or several times, daily, with great bene- 
fit. By these measures, together with the observance of 
good hygiene, he usually effects a cure in most cases. 

Where the disease is complicated by nephritis, he 
orders the child put to bed and administers either 
the hot bath or hot pack twice daily to produce dia- 
phoresis. Or, where the heart's action is good, he 
sometimes induces a free perspiration by means of 
hypodermic injections of pilocarpine, given two or 
three times in the twenty-four hours ; and in addition 
to this alcohol is employed to counteract the depres- 
sion on the heart caused by the pilocarpine. In this 
way he occasionally gives as many as eight injections 
in twenty-four hours, always seeing that the child is 
well stimulated ; this extreme resort is, however, not 
advised in all instances, each case requiring its own 
special treatment. Sometimes Dr. Jacobi uses 
gallic and tannic acid, in doses of gr. v-xv. daily, in 
conjunction with the pilocarpine, and often with very 



DIPHTHERIA. 5 1 

favorable action. The bowels are also kept gently 
open by means of the cautious administration of the 
salines. Toward the later stages he finds iron very 
serviceable when there is much albumen in the urine. 

Dr. C. E. Billington considers diphtheria as 
primarily a local affection, and that its specific con- 
stitutional phenomena are secondary results by ab- 
sorption. He therefore believes local antiseptic treat- 
ment to be the most efficient means of successfully 
combating this disease. In employing this treat- 
ment, however, he at the same time cautions that 
the danger to be most avoided is irritation ; this, he 
advises, may render the method unsuccessful by the 
evil effects which it causes. To remove the foul 
secretions from the throat, the formulae which he 
habitually uses^re as follows : 

9. Potass, chlorat. . . . . 3 ii. 
Glycerinae . . . . . g ss. 
Aq. calcis ..... 3 iiss. 

M. Sig. A teaspoonful every half-hour, to a child 
of two to five years. 

This he usually administers in alternation with 
the following : 

9- Tinct. ferri chlor. . . . 3 i. 

Glycerinae ..... 
Aquae . * . . . aa. 5 i- 

M. Sig. A teaspoonful every half-hour. 



52 DIPHTHERIA. 

Both of these mixtures, he advises, are pleasant to 
the taste, easily taken, and cause not the slightest 
irritation to the parts. In some cases he omits the 
latter with advantage. In addition to these meas-' 
ures, he also sprays the throat very frequently, when 
practicable, and for some minutes by means of the 
hand atomizer, using the following solution : 

1$. Acid, carbol m. x. 

Aq. calcis . . . . 5 iv. 

M. Sig. To be used every half-hour, by the spray. 

Regarding the use of the spray of carbolic acid and 
lime water, Dr. BlLLlNGTON considers it to be a 
remedy of great value, not only in its solvent action 
on the false membrane, but as a most agreeable and 
efficient aid in subduing inflammation. He also 
finds it one of the most reliable means for efficiently 
applying disinfectant treatment to the larnyx ; and 
in his experience it not only sometimes cures, but 
tends to prevent laryngeal diphtheria. In these 
laryngeal cases he uses it as nearly constantly as 
practicable. The careful attention to all these de- 
tails cannot, he advises, be over-estimated. Finally, 
except in bad cases, when he considers this first in 
importance, he reaches the affected surfaces at suit- 
able intervals by means of a syringe, using a weak, 
tepid solution of common salt. This he throws 
through the open mouth into the throat, or, where 



DIPHTHERIA. 53 

the nares appear to be invaded, as shown by a dis- 
charge from the nose or by obstructed breathing, 
through the nostrils into the nasal passages and the 
pharynx ; and continues the process until the foul 
secretions are thoroughly washe'd away and the fetor 
is corrected. The use of throat and nasal syringing 
is regarded by him as of great value, and he believes, 
moreover, that not a few cases terminate fatally 
where these measures are not employed. 

Regarding internal medication, in the treatment 
of young children he finds it very important that 
the employment of any unpleasant medicines, such 
as quinine, cubebs, etc., should be particularly avoided. 
As to the administration of alcohol, he considers it 
useful in the later stages of protracted cases, and 
during convalescence. The prevalent custom, how- 
ever, of a free and early resort to stimulants he be- 
lieves to be injurious, and it is his experience that 
they often add to the poison of the disease, and help 
to overwhelm rather than to sustain ; therefore in a 
great many instances he has treated absolutely with- 
out their use. In all cases, Dr. BlLLINGTON insists 
upon proper nutrition as being of the highest im- 
portance. Milk is preferred by him, given freely and 
often, and even using force if necessary ; when indi- 
cated, also, he advises that rectal alimentation should 
never be omitted. 



54 DIPHTHERIA. 

By this means of treatment, carefully and judi- 
ciously carried out, and with the strictest regard for 
every minute detail, the results obtained by him 
have, as a rule, been most gratifying. 

Dr. A. A. SMITH finds that potassium chlorate in 
doses of gr. i every half-hour, will produce the same 
results as larger doses, and without the danger of 
evil effects ensuing from accumulation of the drug 
in the system, which sometimas happens when admin- 
istered in the ordinary way. Indeed, he believes this 
method will give more beneficial effect on the throat 
inflammation. On this plan he usually prescribes : 

9- Potass, chlorat. . . . gr. xvi. 
Aquae ^i\. 

M. Sig. A teaspoonful every half-hour. 

Dr. FRANCIS Delafield considers the internal 
administration of alcohol and the use of iron and 
potassium chlorate as probably the best means of 
treatment. He gives alcohol, however, not merely 
for sustaining the strength of the patient, but for its 
constitutional effects ; hence in large doses and in 
concentrated form, using brandy or whiskey in doses 
of 3 i. every hour or tzvo, and to the saturation of 
the system. By this means he also finds that the 
drug acts as a cardiac stimulant after the disease 
begins to improve. He advises, moreover, and es- 
pecially in severe cases, that the use of alcohol must 



DIPHTHERIA. 55 

be commenced early. The iron and potassium he 
gives as follows : 

5- Tinqt. ferri chlor. . . gtt. v-x. 

Sig. Dose, every two hours. 

This is alternated with : 

9- Potass, chlorat. gr. x-xv. 

Sig. Dose, every two hours. 

These are administered so that the child gets one 
every hour. The use of soda bcnzoate in large doses 
of gr. x-xxx. every three hours, he also considers an 
excellent plan of treatment in many cases. 

The local measures adopted by him consist in the 
application, in some instances, of carbolic or salicylic 
acid by means of the brush or spray ; or, in others, 
of the tincture of the cliloridc of iron. This, he ad- 
vises, must be made every two or three hours, to 
obtain good effects. Sprays, steam inhalations, and 
vapor of lime, are also used at times. Where, how- 
ever, the larynx is involved and suffocation is immi- 
nent, tracJieotomy is indicated, although he finds it 
even less satisfactory than in croup. 

Dr. Beverly Robinson frequently uses lactic 
acid in the form of a spray with much benefit. The 
solution he employs is as follows : 

I£. Acid, lactic m. xx. 

Aquae ..... 3 i. 

M. 



56 DIPHTHERIA. 

Dr. J. H. Ripley considers the vapor of lime 
water as of little or no service, since the patient gets 
so little of it. He has used it in the form of the 
spray, and poured it by teaspoonfuls into the trachea, 
but the results have been unfortunate. 

Dr. Alonzo Clark uses the spray of lime water 
as frequently and as constantly as indicated, placing 
much reliance on its efficacy when thrown upon the 
forming membrane. 

Dr. L. Elsberg, has found bromi?te to be a much 
more efficient solvent for false membrane, than 
either lime water, lactic acid, liquor potassae, or liquor 
sodae ; and if properly used, he finds that it does not 
cause any irritation. For this purpose he prescribes 
the following : 

IjL Brominii . . . gr. 

Potass, iodidi ... 3 

Aquae . . . . - . % 

M. Sig. For inhalation. 

This, he advises, can be poured into a cone, and the 
child be permitted to inhale the fumes. In his ex- 
perience this solution has better solvent effect on the 
membrane outside, and apparently inside also, than 
either of the above agents. 

Dr. J. R. Leaming has used calomel very effect- 
ually in many instances. This drug, however, he 



DIPHTHERIA. 57 

administers in large doses, and has frequently ob- 
tained the best results in a very few hours. 

Dr. E. C. Wendt has prescribed the muriate of 
pilocarpine with success in many cases, where other 
remedies had been tried without the least benefit. 
This he gives, as advocated by Guttman, by the fol- 
lowing method, which has been found most advan- 
tageous : 

1$. Pilocarpin. muriat. . gr. yi- 2 /i. 

Pepsin gr. \-\%. 

Acid, hydrochlor. . . . gtt. ii. 

Aquae destill. ... 3 iiss. 

M. Sig. A teaspoonful every hour, to a child of 
eight or ten years. 

In conjunction with the above, each dose is fol- 
lowed by teaspoonful doses of old sherry wine. By 
this treatment, kept up continuously throughout the 
night, he has, in many severe cases, observed 
marked improvement in a very short time. 

* The Alcohol, or so called " Brooklyn," 
Treatment of diphtheria, which has yielded such 
excellent results, consists in the administration of 
alcohol, not, however, as in a variety of other dis- 
eases, to relieve or prevent great prostration, but for 
its specific action as an antidote to the diphtheritic 

* The Brooklyn Treatment of Diphtheria may be considered 
as of sufficient importance to entitle it to an insertion here. 



58 DIPHTHERIA. 

poison. In these cases its stimulant or other ordi- 
nary effects are not induced by it, and intoxication 
has never been observed, while enormous doses have 
been administered to young children. Not only, 
moreover, as an antidote, but also as a prophylactic 
of diphtheria is the value of alcohol demonstrated, 
when administered early and in sufficient doses. For 
this latter effect the following prescription is very 
generally employed : 

5,. Cinchon. sulph. . . . 3 i. 

Acid, sulph. aromat. . . . q. s. 
Spts. vini gall. . . • '- • ■ 5 vn - 
Glycerin, opt. . . , § i. 

M. Sig. From a small teaspoonful to a table- 
spoonful every two hours, according to age. 

And even to prevent or cut short any of the se- 
quelae, it is claimed for this plan of treatment that 
there is no remedy so reliable as alcohol. In the 
majority of instances quinine is also administered, 
although in many cases alcohol alone is employed, 
and the effect seems to be almost as decided and 
quick without, as with, quinine. Where the medicine 
is refused on account of the taste of the drug, the 
alcohol is often given separately, and the quinine 
administered by inunction, as follows : 

1$. Quiniae sulph. . 

Chloroformi .... 



DIPHTHERIA. 59 

Bals. peruv aa3ss. 

Adipis 3vi. 

M. 

For the alcohol, the following formula is usually 
employed : 

5- Spts. vini gall. . . . J iiss. § 

Glycerinae opt. .... 
Syrupi simp. . . . . aa § ss. 

Aquae menth. pip. q. s. ad . . 3 iv. 
M. Sig. A teaspoonful every hour, to a child 
under two years. From two to three years, 3 iss., 
from three to five years, 3ii.» and from five to eight 
years, 3 iiss- 5 ss. every hour. 

Or, in many instances the following combination 
may be used very satisfactorily: 

9. Quiniae sulph. . . . gr. xvi. 

Acid, sulph. aromat. . . q. s. 

Spts. vini gall. . . .3 iss. 

Syrup, simp, ad . . . 3 ii. 

M. Sig. A teaspoonful every two hours. 
In addition to the above, whiskey may be given in 
doses of 3 i — i ii - as indicated. Champagne is also used 
in many severe cases. 

The local measures resorted to consist in the ap- 
plication of a light astringent, either in the form of 
a gargle or spray, or as a powder to be blown directly 
on the diseased parts ; chlorate of potassium, powdered 



60 CORYZA. 

alum, and tannic acid, either combined or otherwise, 
with the addition of a comparatively large quantity 
of carbolic acid, being used for this purpose. 

Besides these means of treatment, great impor- 
tance is always attached to hygiene ; cleanliness and 
fresh air commanding primary attention. In regard to 
nourishment, during the first twenty-four hours of 
an attack little or none at all is given, as a rule, but 
in all cases the first food administered consists of 
milk and lime water, with the addition of a little 
salt. During convalescence iron, particularly dia- 
lysed iron, is employed, and, in combination with some 
form of alcohol, either prevents or relieves the con- 
ditions of anaemia and loss of nerve power which 
are so apt to follow diphtheria. 



CORYZA. 



In acute cases, where the attack is of a mild char- 
acter, Dr. J. Lewis Smith advises that very little 
treatment is required. He directs that the bowels be 
kept open, the feet soaked in mustard water, and the 
body warmly clothed. Inunction of tlie nostrils is 
also resorted to, and often with much relief. Where 



CORYZA. 6l 

there are evidences of the extension of the disease 
toward the bronchial tubes, he gives an emetic of 
syrup of ipecac, followed by : 

9. Syrupi ipecac 3 ii. 

Spts. aether, nitr 3 i. 

Syrupi simp 3 ii. 

M. Sig. A teaspoonful every three hours, to a 
child of six months. 

He further employs injections very beneficially. A 
three to five per cent, solution of common salt in warm 
water is used, injecting it into the nostrils with a 
small syringe. This aids materially in removing the 
muco-pus which obstructs the respiration, and in 
establishing a healthful state of the inflamed surface. 
Or, sometimes a mixture of carbolic acid, glycerine 
and water, with a few grains of potassium chlorate 
added, is used instead of salt. 

Chronic cases of coryza, or "snuffles," are usually 
attributed to the strumous cachexia, and often asso- 
ciated with glandular enlargements, etc. For local 
measures, in these patients, Dr. Smith treats by 
injecting into the nostrils with a glass, or hard rubber, 
or rubber ball, syringe, a solution of equal parts of 
lime water and warm water, at a temperature of about 
ioo c , the child being placed on the back with a towel 
laid over the eyes. Internally he gives the follow- 
ing: 



62 CORYZA. 

5-. Olei morrhuae . . . 5 ii. 

Syrupi ferri iodidi ... 3 i- 

M. Sig. A teaspoonful three or four times daily, 
to a child of one year. 

If constipation is present, which is frequently the 
case, he finds this doubly serviceable, since the cod 
liver oil will also act as a laxative besides its effect on 
nutrition. In addition, and especially in chronic cases 
associated with syphilis, he considers the following an 
excellent application to parts which can be reached 
by a camel's-hair pencil, or with a nasal sponge : 

5&. Ung. hydrarg. nitrat. . . . 3 ii- 
Ung. zinci oxidi. . . . § u - 

M. Sig. Apply three or four times daily, as far 
within the nostrils as possible. 

Where the child is anaemic, he further advises that 
a teaspoonful of the juice expressed from rare beef- 
steak be given every two hours. 

Dr. A. A. Smith often uses aconite very bene- 
ficially. In many cases seen at the commencement, 
with more or less fever, and where the skin is hot 
and dry, the pulse full and bounding, and the mu- 
cous membrane of the throat and nostrils dry, he 
gives the following with decided benefit : 

1$. Tinct. aconit. rad. . . m. }4-j4. 
Aquae . . . . . q. s. 

M. Sig. Dose, every fifteen minutes. 



TRUE CROUP. 63 

When perspiration appears, which usually occurs 
in a short time afterward, he then administers the 
drug at longer intervals ; every half-hour or longer, 
according to indications. 

In older children, the following is recommended 
very highly by Dr. J. R. Leaming, as a means of 
aborting a cold if taken early : 
9. Ammon. chlorid. 

Potass, nitrat. . . 

Senegae . . . . . aa 5 ss. 

Glycyrrhizae . . . . 31. 

Aquae Oi- 

M. Sig. 3 ii to § ss. every half-hour. 



TRUE CROUP. 
(acute croupous laryngitis.) 

In the treatment of this disease, Dr. J. H. Ripley 
considers the use of medicinal measures exceedingly 
unsatisfactory. The only rational plan, in his ex- 
perience, is a symptomatic one. Stimulants and extra 
feeding are, however, required in severe cases. If 
seen in the early stage before serious dyspnoea is pres- 



64 TRUE CROUP. 

ent, he at once applies a large warm poultice over the 
larynx and extending nearly down to the root of the 
neck ; it is also made to fit as closely as possible 
without obstructing the circulation or respiration, 
and changed as soon as it becomes cool. This, he 
finds, not only affords comfort but in many cases 
gives, at least, temporary relief. The temperature of 
the room is kept at /o° or 8o°, and the air constantly 
moistened with steam. In addition, if possible, he 
also secures direct application of steam by means of 
the croup-kettle, using it five minutes at a time at 
intervals of fifteen minutes, and finds that it often 
renders most valuable service. While the child is 
sleeping, a gentle stream, not too warm, may also be 
kept up continually. As regards lime water, he does 
not find it any more serviceable than steam, whether 
produced from slaking lime, or thrown by means 
of the spray. The spray is, however, used in many 
cases, and the atmosphere saturated with lime steam 
by means of kettles filled with a mixture of quick- 
lime and water, and kept boiling. 

Concerning emetics, Dr. RlPLEY prefers either the 
sulphate of copper or the yellow sulphate of mercury, 
as most prompt and efficacious. In using them he 
tries the drug once or twice, but no more, as he de- 
cidedly objects to the repeated exhibition of these 
depressing agents, thus exhausting the patient. In 



TRUE CROUP. 65 

addition to the above means of treatment, as a rule, 
he prescribes the following : 

9- Potass, chlorat. . . . . gr. v. 
Tinct. ferri muriat. . . . gtt. v. 

Syrupi 

Aquae . . . . aa q. s. 

M. Sig. Dose, every two hours, to a child of one 
to five years. 

This is, in many instances, continued throughout 
the whole course of the disease. Should diarrhoea 
result from its use, as sometimes happens, the admin- 
istration is stopped and, if required, an emetic is 
given. Stimulants, brandy and milk, are also used 
as indicated. Where there exists a previous history 
of malaria, and with high temperature, quinine is or- 
dered ; in some instances giving ; 

9- Quinise sulph. gr. xx. 

Sig. This amount during the twenty-four 
hours, to a child of two or three years. 

Or, in others, gr. v. is administered, and the dose 
repeated in one or two hours. In older children 
gr. x. may be given at night, followed by gr. v. in 
the morning, and this amount increased as de- 
manded. 

Sometimes, instead of the potassium chlorate and 
iron solution, he finds bromine very serviceable, 
thus: 

5 



66 TRUE CROUP. 

I£. Brominii . . . . . 3 ss. 
Aq. cinnamomi .... 3 iv. 

M. Sig. A teaspoonful every two hours, taken in 
milk. 

This may also alternate with stimulants" in the 
form of milk punch. He advises, however, that the 
bromine often causes marked gastric irritation, and 
cannot be continued with regularity. If the case is 
seen early and patches are discovered on the tonsils, 
he sometimes cauterizes them with a solution of 
silver nitrate, and prescribes bromine internally, as 
above. 

When, however, all these measures are unavailing, 
and medicinal treatment has failed either to relieve 
or to check the progress of the disease, and with 
exhaustion and cyanosis approaching, Dr. Ripley 
immediately resorts to tracheotomy. In such a case 
the after treatment, he advises, requires the utmost 
care and attention. The child should be seen every 
eight hours, for the first few days following the 
operation. Usually during the first twenty-four 
hours nothing unfavorable occurs. If the breathing 
is perfectly free, he fastens a large moist sponge over 
the mouth of the tube, which accomplishes the two- 
fold purpose of warming and of moistening the air, 
and can easily be kept clean, while it also allows of 
a ready manipulation of the tubes. Should the 



TRUE CROUP. 6j 

breathing be at all harsh, he directs that the inhal- 
ation of steam from the croup-kettle be continued. 
: . in any case, he finds that it is usually best to 
keep the air of the room moist, and at a temperature 
of 70 3 or 8o°. The inner tube is taken out and 
cleaned as often as it becomes obstructed : but, on 
the second day, as a rule, he removes both tubes, 
cleaning them thoroughly and applying new tap :.- 
while at the same time, also, the wound is cleaned, 
and the larynx examined as to its permeability. 
When returning the tube, he usually places a washer, 
formed of several folds of muslin, or other material, 
and smeared with a mild ointment, between the 
plate and wound, thus affording much comfort to 
the patient. The tube is permanently removed as 
soon as respiration can be carried on through the 
larynx. 

Dr. J. R. Le amino recommends the following 
as often rendering excellent service : 

R. Potass, chlorat. . . . . 3 ii. 

Ammon. chlorid. . . . . -3L 

Aquae cinnamom. ... 3 iii. 

Syrup, senegae . . . 3 ss. 

Spts. aether, nitros. . . . 3 ss. 

Ext. glycyrrh. . . . . 3 iss. 

M. Sig. A teaspoonful to a tablespoonful. accord- 
ing to age. even- two hours. 



68 TRUE CROUP. 

He also combines iron with the above, when re- 
quired, according to indications. 

Dr. J. Lewis Smith directs that the atmosphere 
of the room in which the child is placed, be con- 
stantly loaded with moisture, thus rendering the 
cough looser and promoting expectoration. Any 
degree of. heat, however, which would add materially 
to the discomfort of the patient, must be avoided. 
A temperature of 75 to 8o° is usually required. 
The following is, in his experience, the most efficient 
solvent for the false membrane, and should be used 
almost constantly, by means of the atomizer : 

1$. Liq. sodae (or potassae) . . 3 i. 

Aquas calcis § vii. 

M. 

This is freely sent directly to the inflamed surface 
in the form of a spray. 

For internal treatment, an emetic is first adminis- 
tered, for which purpose, as a rule, he prefers the 
yellow sulphate of mercury, in powder, in doses of 
gr. ii. In addition to this, he prescribes the follow- 
ing mixture with much benefit : 

5- Potass, chlorat. 

Ammon. muriat. . . aa 3 1 — 51- 

Syrup. simp §i. 

Aquae ..... 5 ul *« 

M. Sig. A teaspoonful every hour. 



TRUE CROUP. 69 

As regards local measures, Dr. SMITH employs 
cold water, especially in the early stages, preferring 
this measure, in most cases, to the use of poultices. 
This may be dropped constantly from a sponge, 
upon a compress laid over the throat of the child ; 
or, two or three thicknesses of muslin soaked with 
camphorated oil, are applied over the larynx, so as 
to cover the neck in front, and over this is placed a 
bladder containing pieces, of ice, or ice surrounded 
by oil-silk. If dyspnoea becomes severe, the inhala- 
tion of oxygen is often found of great service. As to 
the advisability of tracheotomy, he considers this 
resort, when indicated, proper and justifiable, and 
advises that it should not be delayed. 

To control the inflammation Dr. FRANCIS DELA- 
FIELD employs leeches, in strong, healthy children, 
applied over the region of the larynx ; and following 
this measure with hot or cold applications around 
the throat, either ice-bags, or sponges wrung out of 
hot or cold water. The child is also made to breathe 
vapor of some kind, either hydrating lime, or hot or 
medicated water ; or the room is filled with steam, 
or the steam tent used. For internal medication, at 
the commencement he gives an emetic, usually 
antimony in small doses, combined with a small 
amount of opium. Regarding the administration of 
calomel to the point of salivation, he discountenances 



70 TRUE CROUP. 

this practice ; but advises that if given in small 
doses until the bowels move, and then discontinued, 
much benefit is often derived from its use. On this 
plan he prescribes : 

9- Hydrarg. chlor. mit. . . gr. ss-i. 
Sig. Dose, every one or two hours. 

For the restlessness, small doses of opium in some 
form are given. When signs of insufficient aeration 
of blood are present, the inhalation of oxygen is em- 
ployed, affording great relief. If, however, the dis- 
ease is so far advanced that the breathing is ob- 
structed, he resorts to tracheotomy. In regard to 
this procedure, Dr. Delafield advises that if the 
operation is performed while the local inflammation 
is running its course, the chances of recovery are 
much greater. Therefore, in cases where the bronchi 
are not involved, as soon as it is evident that the 
disease is not yielding, and deficient aeration is 
prominent, he operates at once, with considerable 
hope of this resort being not only beneficial but 
successful. 

If seen at the onset of the disease, Dr. A. Had- 
DEN usually administers a dose of castor oil, suffi- 
cient to move the bowels. He then places a napkin 
wrung out of cold water about the neck, directs that 
the child be confined to bed, and prescribes the fol- 
lowing : 



TRUE CROUP. 71 

5. Tinct. ferri chlor. 

Sodse chlor. . . . aa 3 i. 

Glycerinae . . . . . § ss. ■ 

Aquae pur. .... § iiss. 

M. Sig. A teaspoonful every hour, to a child of 
three to six years. 

In many cases, where the false membrane is con- 
fined to the tonsils, he applies the following astrin- 
gent mixture to the affected parts, finding it of great 
value, and particularly so when the membrane does 
not extend to the larynx : 

9. Liq. ferri sulphatis . . . 3 i. 

Glycerinae § i. 

Mo Sig. To be applied repeatedly, by means of 
the throat brush. 

Should the appearance of the membrane increase 
and with a tendency to spread, he often uses the fol- 
lowing with good effect : 

9. Potass, chlorat 3 ii. 

Aquae ...... Oi. 

M. Sig. Gargle. 

When, however, the croupy condition becomes 
more manifest, with hoarseness, etc., he directs that 
the temperature of the room be maintained at J0° to 
8o°, and the air kept constantly moist with steam. 
Lime is also slaked in the apartment so that the pa- 
tient can breathe the fumes ; this is found to have a 



72 TRUE CROUP. 

very soothing effect, and constitutes a means of re- 
lief upon which Dr. HADDEN places great reliance. 
In addition to these measures he frequently pre- 
scribes bromine, to be taken internally, with much 
benefit. In some instances turpeth mineral is given, 
as an emetic and for its alterative action. If the 
symptoms increase in severity, in spite of these means 
of treatment, and the croupy cough continues, he 
often finds the application of a strong solution of 
silver nitrate, by means of a probang, very service- 
able in lessening the symptoms and checking the ex- 
udation. 

If, however, all endeavors are unavailing and 
the case still progresses unfavorably, he resorts to 
tracheotomy. Regarding this procedure, he believes 
that the operation, when indicated, is not only prac- 
ticable but imperative, and in many cases the only 
expedient that can hold out the least hope of saving 
life. And in all cases he operates as soon as suffo- 
cation threatens, and it is evident that medicinal 
measures are not likely to* afford relief. After the 
canula is in position, Dr. HADDEN also considers it 
a very essential part of the treatment, to make ap- 
plications through the tube, by means of a soft 
feather, of the above solution of iron and glycerine, 
to the inner surface of the trachea. This he repeats 
as frequently as every two or three hours during the 



TRUE CROUP. 73 

day, and believes the success following the operation 
to be, in a great measure, dependent upon this pro- 
cedure. 

Dr. A. L. LOOMIS directs that the child be placed 
in a large room, the air of which is kept moistened, 
and th£ temperature at about y6° ; this he considers 
to be of the highest importance. In many instances 
the tent is used, and steam from boiling molasses and 
water carried into it. Lime vapor is also used with 
good effect. If seen at the onset, before the for- 
mation of any false membrane, he often derives 
much benefit from the administration of quinine in 
large doses, with the object of aborting the laryngeal 
inflammation, or preventing its assuming a croupous 
form. For this purpose he usually prescribes : 

5-. Quiniae sulph. . . . gr.xxx. 

Sig. gr. v. every four hours, for twenty-four 
hours, to a child of three years. 

When the false membrane is present, however, in- 
halation constitutes his sole reliance for safety. 
Should signs of imperfect aeration appear, oxygen is 
often of great service ; a stream being passed into 
the tent, or direct inhalation employed. In addition 
to these measures, hot cloths or sponges, squeezed 
dry (from boiling water), are continuously applied to 
the neck. For an emetic, when indicated, he prefers 
zinc sulphate. Direct local applications, he advises, 



74 SPURIOUS OR CATARRHAL CROUP. 

do more harm than good. He has also very little 
faith in the various specifics used in this disease. Re- 
garding diet, this is made of the most nutritious 
character throughout, and when called for stimulants 
are freely given to sustain the vital powers. 

Finally, Dr. LOOMIS advises that the resort to 
tracheotomy, to be of service, must be made early, 
if at all ; and not, as is so often the case, after the 
child has passed beyond all hopes of recovery. 

Dr. AUSTIN Flint believes that the operation of 
tracheotomy is not only justifiable, but that it is a 
duty which should, if possible, be performed, when- 
ever it is evident that the child is dying from suffo- 
cation. 



SPURIOUS OR CATARRHAL CROUP. 
(acute catarrhal laryngitis.) 



Dr. J. Lewis Smith finds that most cases do well 
under suitable hygienic treatment, and without the 
use of any medicines whatever. He uses demulcent 
drinks, however, with much benefit, together with an 
occasional laxative. To relieve the cough, when 



SPURIOUS OR CATARRHAL CROUP. 75 

troublesome, he uses a mixture of paregoric and 
syrup of ipecac, with marked benefit. Or, he some- 
times finds a small Dover s powder fulfills this indica- 
tion very effectually. For the restlessness a warm 
mustard foot-bath usually affords relief. Inhalations 
of a spray of glycerine and water are also used by 
him with good effect, together with mild . applica- 
tions, such as camphorated oil, rubbed over the part 
several times daily. 

Dr. Francis Delafield advises against any 
unnecessary alarm, thereby causing the child to be 
treated much more energetically than necessary. 
Mild cases, he finds, may require little or no treat- 
ment at all. To increase the secretion of mucus, 
and thus relieve the stridulous cough and breathing, 
he administers tartar emetic in small and frequently 
repeated doses, thus : 

1$. Vini antimonii . . . gtt. v-x. 

Sig. Dose, according to age, every one to 
three hours. 

If this amount causes vomiting, he directs that the 
drug must not be discontinued, but the dose dimin- 
ished to gtt. v. ; and if emesis is still produced, 
he then reduces this to gtt. ii-iii., or until he ascer- 
tains what amount the patient can take without 
vomiting. For the restlessness, one of the opium 
preparations is given in small doses ; using either 



j6 SPURIOUS OR CATARRHAL CROUP. 

Dover's powder, paregoric, or laudanum, or he often 
finds the syrup of poppies very serviceable. To 
relieve the dyspnoea, especially in spasmodic attacks, 
if it is very severe and the fever high, he gives an 
active emetic, either of the following being preferred 
for this purpose : 

]J. Jiydrarg. sulph. flav. . gr. iii-v. 

5- Vini antimonii . . . 3 i. 

^. Vini ipecac. . . . . 3 i- 

In severe cases of dyspnoea, tracheotomy is indi- 
cated, and is, he finds, sometimes the only relief. 
In regard to this resort, Dr. DELAFIELD advises not 
to delay too long ; after one or two severe attacks 
the third should not be waited for, as it may prove 
fatal. In those cases where the disease is pro- 
tracted, or evinces a tendency to become so, lasting 
from ten days to two weeks, he considers the 
administration of a brisk purge, followed by tonics 
afterward, as the best means of breaking up the dis- 
ease. On this principle, he gives calomel every hour 
until the bowels move, up to gr. v. being usually suf- 
ficient ; after which, he stops the calomel and admin- 
isters quinine in doses of gr. i-i. By this means, 
satisfactory results generally follow. 

Dr. A. L. LOOMIS considers rest to the part of 
primary importance. He directs that the patient be 
confined in a warm room, the air of which is kept 



SPURIOUS OR CATARRHAL CROUP. J7 

moist by steam, and the temperature at about 758. 
Where there is very little or no induration present, 
he finds that the persistent use of inhalations of 
vapor are of the greatest service, and believes this 
measure to be far superior to any other local means 
of treatment. He objects to the use of antimony or 
calomel, as well as to the application of blisters or 
leeches. For internal medication, he resorts to the 
early administration of quinine in large doses, with a 
view to rapidly producing the effects of the drug. 
On this plan, especially if begun at the outset, he 
has frequently succeeded not only in controlling but 
in arresting the progress of the disease. This, in a 
severe case, he usually gives as follows : 

Ijfc. Quiniae sulph. . . . gr. xx. 

Sig. This amount during the first twenty- 
four hours, to a child of three years. 

Should these means fail and oedema come on, 
scarification is practiced. When, however, this can- 
not be done, or is useless, and suffocation is evident, 
he resorts to tracheotomy ; advising, moreover, 
against too great a delay in this respect. 



yS LARYNGISMUS STRIDULUS. 

LARYNGISMUS STRIDULUS. 

(spasmodic croup.) 



In ordinary cases, to relieve the spasm, Dr. J. 
Lewis Smith places the child in a warm bath, of a 
temperature of ioo°, as soon as possible after the 
onset of the attack. The bath is continued for ten 
or fifteen minutes, after which he administers an 
emetic, as follows : 

5- Syrup, ipecac 3 i. 

Sig. Dose, to a child under three years. 

This is repeated in twenty minutes, or until vomit- 
ing occurs. Or, in the majority of cases, he finds the 
following combination more prompt in action than 
ipecac alone : 

9. Aluminis 3 ii- 

Syrup, ipecac.- . . .. . § i. 

M. Sig. A teaspoonful. 

In children over three years of age, he considers 
the syrup, scillce co. in doses of 3 i as having the best 
effect ; one or two doses being usually sufficient for 
this purpose. In addition to these means of treat- 
ment, if the bowels are not already loose, a purge is 
administered. Inhalations of steam are also used, 
and often the application of a sinapism over the neck 
is followed by marked benefit. Where the nervous 



LARYNGISMUS STRIDULUS. 79 

character is more prominent, he derives much satis- 
faction from the administration of quinine, as follows : 

9. Quiniae sulph. ... gr. i. 

Sig. Dose, three or four times daily, to a 
child of three to five years. 

If cachexia is more or less marked, tonics, iron, 
etc., and plenty of fresh air, are required. As a rule, 
under this treatment, and with proper management, 
the symptoms disappear and convalescence soon 
follows. 

Dr. A. L. LOOMIS directs his attention primarily 
to the removal of the cause ; e. g., indigestion, teeth- 
ing, etc. If the spasm continues he gives an emetic, 
or orders a hot bath, which are often found to act 
beneficially. In very severe attacks, however, when 
relief does not follow, and death seems impending, 
tracheotomy is resorted to. 

DR. W. H. THOMSON finds the cold douche applied 
to the nape of the neck, often very serviceable in re- 
lieving the crowing respiration. 

Dr. A. A. Smith advises that in most cases of 
spasmodic croup of reflex origin, the following will 
usually afford relief : 

9. Atrophias sulph. . . . gr. yfg-. 
Aquae Oss. 

M. Sig. A teaspoonful every hour. 

Or, if necessary, the dose is repeated every half- 



80 LARYNGISMUS STRIDULUS. 

hour, according to the severity of the attack. Should 
the child's face begin to flush and show signs of the 
the physiological action of the drug, he then reduces 
the frequency of administration. Attention is also 
directed to the stomach, and if it contains anything 
which can be causing the spasm, an emetic is given ; 
or a cathartic, if there is reason to suspect intestinal 
disturbance as the cause. 

Dr. Francis Delafield, in treating those cases 
which occur among weak and poorly nourished 
children, and in rickety subjects, directs his measures 
toward improving the general health and nutrition 
of the patient by means of good food -and, tonics, such as 
iron, quinine, cod liver oil, etc., and by sponging off the 
child with cold water each morning. Antispasmodics 
are avoided. At the onset of the attack he advises 
that nothing special in the way of treatment is called 
for ; but if the spasm continues and suffocation is 
imminent, tracheotomy should be performed, al- 
though probably with very little benefit. In sud- 
den emergencies, however, he directs that an ordin- 
ary silver catheter be passed through the opening of 
the glottis into the larynx and trachea, thus estab- 
lishing respiration ; and after this is again secured, 
the instrument may be withdrawn when the breath- 
ing will usually continue. 

In other cases, where the affection is purely mus- 



LARYNGISMUS STRIDULUS. 8 1 

cular, Dr. Delafield administers an emetic, pre- 
ferring the following : 

9- Hydrarg. sulph. flav. . . gr. iii.-v. 
Sig. Dose, to be repeated if necessary. 

Or he sometimes uses the wine of ipecac in doses of 
3 i. In either case he combines the use of the hot 
bath very effectually with the above. After emesis 
has taken place, should the child again commence to 
have difficult breathing, the emetic is repeated. To 
prevent a recurrence of the disease, he finds the 
bromides and assafcetida most efficacious ; or some- 
times opium, chloroform, or compound spirit of 
ether have good effect. 



HOOPING COUGH. 



Dr. J. Lewis Smith has treated several cases at 
the New York Foundling Asylum, with very favor- 
able results, by inhalation of the follow 
9. Acid, carbol. 

Potass, chlorat. . 
Glycerinae .... 
Aquae .... 

M. Sig. Spray. 
6 



3ss. 
3 if. 

§ii. 
3 vi. 



82 HOOPING COUGH. 

This is to be inhaled three times daily, and from two 
to five minutes each time. The good effects, he ad- 
vises, seem at times to be due principally to the car- 
bolic acid, although in one or two cases, where the 
experiment was made of omitting the chlorate of 
potash temporarily, the patient apparently did better 
without it. 

Dr. A. Jacobi advises the importance of never 
allowing the disease to run on for months, reasoning 
that it is self-limited and must take a certain course-. 
But every endeavor should be exerted to cure the 
case in five or six weeks, for if permitted to continue 
it may give rise to secondary pneumonia. These 
pneumonias, occurring secondary to hooping cough, 
are most ^dangerous complications, and every means 
should be employed to prevent them. 

At St. Luke's Hospital, Dr. J. R. LEADING has 
used cerium oxalate in doses of gr. Hi— v. with much 
benefit in allaying the cough. 

Dr. H. S. Dessau prescribes the following with 
excellent effect, in the convulsive stage : 

Ijfc. Chloral, hydrat 3i. 

Potass, bromid. . . . . 3 ii. 

Syrup, pruni virg. 

Aquae aa § i. 

M. Sig. A teaspoonful three times daily, to a 
child under one year. 



HOOPING COUGH. 



33 



Dr. A. L. Looms directs that all exposure be 
avoided, the child placed on a simple nourishing 
diet, and the condition of the alimentary tract be 
carefully attended to. In older children, he advises 
that they be instructed to restrain the 'cough when 
possible. To lessen the intensity of the paroxysms, 
he finds belladonna very serviceable in some instan- 
ces ; in others, hydrocyanic acid or cannabis indica 
affords most relief. He advises, however, that these 
drugs should be given in very small doses, and their 
effects carefully watched. Topical applications and 
counter-irritation he believes to be harmful ; and he 
has no faith in the numerous specifics recommended 
for this affection. For the complications occurring 
in the course of the disease, these are promptly met 
in the usual manner, together with supporting 
measures. In many cases tonics, iron, quinine, and 
cod liver oil, are found very beneficial ; and in all in- 
stances during convalescence, the administration of 
these remedies is usually called for. 

The following mixtures are much used at BELLE- 
vue Hospital, in this disease 

9- Potass, bromidi . . . gr. xvi. 
Syrup, ipecac. 



Tinct. opii camph. 
Syrup, lactucarii 
Syrup, tolutan. 



aa 5 ss - 



84 EPISTAXIS. 

Aquae q. s. ad ... § iv. 

M. Sig. A teaspoonful. 
Or this : 
9-. Tinct. nucis vom. . 3 ii. 

Vini ipecac. ... 3 iiss. 

Syrup, sarsap. co. 

Syrup, senegse . . . aa 3 iss. 

M. Dose : A teaspoonful. 

At the Infants' Hospital the following is used 
with very gratifying results : 

1$. Acid, nitric, dil. . . . 3 i. 

Syrup, pruni virg. . . . § ss. 

Aquae q. s. ad ... § ii. 

M. Dose : A teaspoonful. 



EPISTAXIS. 



Dr. A. Jacobi advises that in all cases when the 
bleeding is profuse, it should be stopped at once, if 
possible, on account of the drain on the general sys- 
tem. He considers it a very bad plan to wash out 
the nares freely with water and weak astringents, 
since this interferes with coagulation which is essen- 
tial for the control of the hemorrhage. Styptic cot- 



EPISTAXIS. 85 

ton, or the persulphate of iron, he finds very service- 
able in these instances. Or, in some cases, when 
necessary he uses Bellocs canula, closing up the en- 
tire nasal tract to effectually stop the bleeding. In 
addition, he advises that it is desirable to avoid all 
tight pressure about the body, and directs that the 
child be made to take very deep inspirations, filling 
the chest to the utmost extent, so that there maybe 
as small an amount of blood as possible for the nose. 

Dr. G. M. Lefferts uses the following with very 
good effect : 

9- Acidi tannic j§ ss. 

Pulv. acaciae .... 

Sacchari alb. . . . aa 3 ii. 

M. Sig. For insufflation. 

Dr. W. H. Draper finds that stuffing the nares 
with lint dipped in ice-water is often successful in 
arresting the hemorrhage. Or, in some instances, 
plugging the nares, either anterior or posterior, or 
both, is required. Internally, in cases of severe 
bleeding, he gives ext. ergot, fl. in doses of m. xv- 3 ss. 
every two hours, together with gallic acid gr. ss-ii. 
in capsules. 

Dr. Alonzo Clark sometimes uses pressure very 
serviceably in checking the hemorrhage. When, 
however, the bleeding is very profuse, causing con- 
siderable pallor, etc., and in obstinate cases where 



86 EPISTAXIS. 

this means fails to relieve, he finds that a spray of 
the following solution, when thrown into the nostril, 
is quite efficacious : 

9- Liq. ferri persulph. . . . 3 i. 

Aquae 3 iv-vi. 

M. 



PART III. 

DISEASES OF THE DIGESTIVE 
ORGANS. 



STOMATITIS. 



In cases of simple stomatitis, Dr. J. LEWIS 
SMITH considers the adoption of suitable hygienic 
measures of the greatest importance, and in many 
cases not any medicinal treatment whatever is called 
for. Locally he uses borax with very good effect, as 
follows : 

5- Sodii biborat. . . . . 3i. 

Glycerinae 

Aquae . . . . aa § ss. 

M. 

The ulcerative form, he advises, requires the most 
careful attention to cleanliness, good surroundings, 
and plenty of fresh air. Tonics are also used, iron 
and the vegetable bitters, with also cod liver oil, when 
indicated. For local treatment, he considers the 



SS STOMATITIS. 

chlorate of potassium as probably the most efficient 
remedy, giving it thus : 

9. Potass, chlorat. . . . 3-ssi. 

Mellis §ss. 

Aquae gii. 

M. Sig. A teaspoonful every two hours. 

This, he directs, should be taken in,to the mouth 
and permitted to flow over the affected parts, to ob- 
tain its' local effect. 

In cases of cancrum oris, Dr. Smith endeavors 
to build up the constitution by good nutritious food, 
tonics, etc. To arrest the gangrene, he has in sev- 
eral instances derived good results from the follow- 
ing : 

5- Cupri sulph. . . . . 3ii. 

Pulv. cinchonas . . . . § ss. 
Aquae . . . . § iv. 

M. 

This he applies twice daily over the entire ulcerated 
surface. If this means fails, however, and the gangrene 
continues to spread, he then uses strong muriatic 
acid, applying it carefully by means of a camel's-hair 
brush, touching only the diseased parts. This is at 
once followed by an alkaline wash. 

Dr. J. H. Ripley, and also Dr. C. J. Macguire, 
has used bismuth successfully in a large number of 
cases of cancrum oris, as well as in ulcerative stoma- 



STOMATITIS. 89 

titis. The following plan is adopted by him. After 
thoroughly cleansing the mouth and the cavity in 
the cheek with the following disinfectant lotion : 

]jfc. Potass, permang. . . . 3 i. 

Aquae §iv. 

M. Sig. To be applied once daily, 
he then clips away all the gangrenous tissue, and 
packs the ulcerated surface with bismuth subnitrate, 
repeating the process every three hours ; at the same 
time washing out the mouth with a solution of car- 
bolic acid, or the permanganate of potash solution. 
The effect of this treatment is a clearing away of 
the slough, frequently within twenty-four hours, a 
lessening of the fetor, and a diminution of the gen-' 
eral symptoms. Constitutional treatment is also 
carefully attended to. Sympi ferri iodidi, or quinine 
and iron, and cod liver oil are administered internally, 
together with a generous and nourishing diet. This 
local application of subnitrate of bismuth is claimed 
to be almost a specific for this terrible malady. In 
nearly every instance the treatment has invariably 
been followed by good results ; an immediate im- 
provement in the appearance of the ulcers takes 
place, and eventually a complete cure. 

The value of bismuth in gangrenous stomatitis, as 
well as in the ulcerative form, has also been fairly 
tested at the Nursery and Child's Hospital. 



90 TONSILLITIS. 

The parts are first thoroughly cleansed with carbolic 
acid solution, cauterized with the solid stick of silver 
nitrate, and then packed with bismuth. Iron, qui- 
nine, and whiskey, are also given according to indica- 
tions. In one case, however, bismuth failed, while 
alum cured the disease. From the results of the 
bismuth treatment in this hospital, and from ex- 
perience, more confidence is expressed in the use of 
the solid nitrate of silver, followed by the applica- 
tion of alum, or, what is considered better, alum 
combined with bismuth, than in the use of bismuth 
subnitrate alone. Moreover, bismuth is regarded as 
being no more of a specific for ulcerative stoma- 
titis and cancrum oris, than is pilocarpine for diph- 
theria. 



TONSILLITIS. 



In cases seen at the onset, Dr. A. Jacobi has 
found usually prompt improvement take place under 
the administration of potassium chlorate and the mu- 
riated tincture of iron. Should any whitish films 
appear, after removing them he often uses a spray of 
silver nitrate, of the strength of 1-500, with good 



TONSILLITIS. 91 

effect. In regard to unilateral inflammation of the 
tonsil or pharynx, he calls attention to the rarity of 
its occurrence, and advises that when present it 
should arouse a suspicion as to the existence of a 
contagious disease, and especially diphtheria. 

Dr. J. R. Leaming finds that, if seen at the com- 
mencement of the attack, the disease may often be 
aborted. For this purpose he gives the following 
very successfully : 

9. Hydrarg. chlor. mit. . . . gr. ii. 
Antim. et potass, tart. . . . gr. -$-. 
Sacchar. .... gr. iii. 

M. Sig. Dose, every three hours, to a child of 
eight to ten years. 

This he places dry upon the back of the tongue, 
and repeats the dose, as above, until free catharsis is 
produced. Or, when the inflammation is too far ad- 
vanced to be aborted, he also uses this prescription 
with marked benefit in hastening the suppurative 
stage. 

Dr. Francis Delafield first administers a purge 
of calomel, after which he endeavors to abort the dis- 
ease, if possible, by means of cold both within and 
without, together with the internal use of aconite. 
When the inflammation has gone on to suppuration, 
he then discontinues the aconite and resorts to warm 
applications, steam inhalations, etc. If there is much 



92 TONSILLITIS. 

pain present, opium in some form is given to relieve 
it. When accumulations of mucus take place in 
the mouth, he finds a mild solution of alum or borax 
very effective in removing them, used either as a 
wash or gargle. In regard to surgical interference, 
he advises that if the swelling of the tonsils is not 
very great, and the discomfort of the patient not 
beyond endurance, the knife should not be resorted 
to. In any case, however, no attempt should be 
made to open the abscess before the fifth or sixth 
day ; not until it has pointed, or until the yellow pus 
can be seen through the mucous membrane. As a 
rule, too early cutting, he finds, does harm, and 
while the sufferings of the patient must be the guide 
to this procedure, yet he considers it much better to 
let the tonsil break of itself, if possible. Where the 
uvula is involved, causing much distress, he obtains 
considerable relief from touching it with the scarifi- 
cator ; or, if necessary, passing a bistoury into it, 
cutting from above downward. The following is 
very extensively employed at BELLE VUE HOS- 
PITAL : 

5- Sodii biboratis . . . . 3 h\ 

Fermenti 

Mellis aa § ss. 

Aquae q. s. ad . . § viii. 

M. Sig. Gargle. 



TONSILLITIS. 



93 



Dr. F. H. BOSWORTH believes that he has, in 
many cases of commencing tonsillitis, aborted the 
disease before the suppurative period has been 
reached. To accomplish this, he gives qninicz sidph. 
gr. x. followed by : 

1$. Tinct. aconit. rad. (Fleming) gtt. v-x. 
Aquae q. s. 

M. Sig. Dose. 

This is repeated until dryness of the throat, nausea, 
and ringing in the ears, show their constitutional 
effects. 

Dr. W. H. Draper is sometimes able to abort 
the inflammation by the use of small blisters and 
poultices. SinaCy which has been said to be a cure, 
will, in his experience, fail more often than it will 
succeed. Astringent washes and gargles are also 
used by him, at times, together with the internal 
administration of aconite and belladonna to control 
the circulation in this region. The following car- 
bolic throat spray, used at New YORK HOSPITAL, 
is a most excellent and valuable combination : 

]J. Sodii bicarb. 



Sodii biborat. . 




aa 3 i. 


Acidi carbol. 


. 


gr. xl. 


Glycerinae 


. 


3 vii. 


Aquae 


. 


5 viii. 



M. 



94 TONSILLITIS. 

Dr. F. A. Burrall finds that gargles are of 
marked service as a temporary substitute for poulti- 
ces, a warm gargle frequently repeated affording 
much relief and aiding suppuration. He also ad- 
vises that constitutional treatment should not be 
neglected ; a mercurial purge at the beginning is 
considered of great value. When the case is seen at 
the onset, he prescribes the following with very 
satisfactory result, and advises that if used at the 
first intimation of the attack, its beneficial effects are 
often remarkable : 

5- Acid, carbol. gr. xx. 

Glycerinse .... §i. 

Sodii chloridi ... 3 i- 

Aquae ferv. .... Oss. 

M. Sig. Gargle, to be used every half-hour. 

Dr. G. M. Lefferts directs attention to the fact 
that when once a patient has suffered from this dis- 
ease, a second attack is more liable to occur. In 
order to prevent this recurrence, if there is chronic 
inflammation he advises that the tonsil be excised ; 
or if it is too small for this operation to be per- 
formed at any other time except when it is acutely 
inflamed, it should be done then. By this means he 
believes that the chances of recurrence are almost 
avoided, although even this, he finds, will not always 
prevent a return of the inflammation. For the 



TONSILLITIS. 95 

affection itself, when the development of suppura- 
tion is once assured, he treats it as an abscess else- 
where. He is doubtful as to the possibility of abort- 
ing it. Silver nitrate, when applied for this purpose, 
he finds, only produces separation of the slough, and 
causes pain and annoyance to the patient. Constant 
application of heat and moisture, internally and ex- 
ternally, he considers the best remedial means. As 
to medicated sprays, although possibly of some 
benefit, yet he thinks it questionable whether it is 
not merely the warm vapor that produces the result. 
He believes there is no better treatment than by the 
hourly inhalation of steam, as hot as can be borne, 
combined with the following gargle : 

1$. Zinci chloridi . . gr. ii-iii. 
Aquae Ji. 

M. 

Regarding gargles, however, he advises that they 
are not always of service, and sometimes do positive 
harm. Using them three or four times daily is con- 
sidered insufficient. He directs the patient to use 
only a tablespoonful at a time, but to repeat it at 
least a dozen times a day. The partial act of swal- 
lowing he finds an excellent manner of doing this ; 
or by throwing the head backward and simply letting 
the fluid flow back by force of gravity, is just as 
efficacious and more easily accomplished. He also 



g6 TONSILLITIS. 

objects to the application of leeches and counter-irri- 
tants, as these measures only serve to exhaust the 
patient's strength. In his experience, also, as little 
medicine as possible should be given, and if an 
emetic is tried, a non-depressant one should be used. 
Cathartics are also employed to relieve congestion of 
the alimentary tract. Regarding scarification, he 
believes there can be no doubt as to its propriety, 
since it causes little or no pain, affords relief at 
once, and may open into an abscess or make its sub- 
sequent spontaneous opening more easy by leaving 
a path for it. When the existence of pus is made 
out, he opens it at once. The following is also 
much used by him: 

R. Potass, chlorat. ... 3 ss-ii. 

Glycerinae 3 ii- 

Aquae §x. 

M. Sig. Gargle. 

In cases of chronic enlargement of the tonsils, Dr. 
LEFFERTS thinks that too little regard is paid to 
active treatment, and directs attention to the unwil- 
lingness of parents to use remedies, as they believe 
that the children will outgrow it. He finds that 
where the case is comparatively recent, the tumor is 
soft and constitutional treatment will often result in 
its absorption. Local measures are also tried at 
times, such as application of silver nitrate, massage 



TONSILLITIS. 97 

of the tonsil, etc. But when the enlargement is of 
long standing and the tonsils have become indurated, 
a train of more serious results may follow. In such 
cases, therefore, he resorts to excision, believing that 
the results of other methods, iodine, caustics, etc., 
are unsatisfactory. He advises, however, that it is 
not necessary to remove the whole gland, only the 
part in front of the anterior palatine fold ; but the 
subsequent cicatrization must not be counted upon 
too much. 

Dr. Beverly' Robinson also advises excision of 
the tonsils, where there is a condition of chronic 
hypertrophy and enlargement. If, however, this 
cannot be done, he sometimes uses silver nitrate with 
good effect. 

Dr. 'Frank H. Hamilton regards an hypertro- 
phied condition of the tonsils as one form of mani- 
festation of the strumous diathesis. He finds, more- 
over, that these enlargements have usually their own 
definite period of growth and decline. They com- 
mence generally, according to his observations, about 
the second or third year of life, and usually reach 
their highest development about the tenth or twelfth 
year ; after which they gradually diminish in size, 
and are rarely sufficiently large after about the 
twentieth year, to cause any inconvenience. There- 
fore he does not consider that the mere fact that the 
7 



98 PHARYNGITIS. 

tonsils are enlarged, justifies excision, and this he*is 
in the constant habit of saying to parents who bring 
their children to him. In any case, however, he 
would not operate when the tonsils were in the 
slightest degree inflamed, unless the danger of suffo- 
cation was imminent, from fear of setting up acute 
inflammation or causing copious and frequently 
recurring hemorrhage, either of which might prove 
fatal. He also considers the existence of a decided 
hemorrhagic diathesis a strong contraindication to 
operation. Dr. Hamilton prefers to use his own 
modification of Owen's instrument, after which the 
bleeding is, as a rule, very trifling, and usually ceases 
in a few moments of itself, or by washing the throat 
with cold water. 



PHARYNGITIS. 



Where chronic pharyngitis, which, as a rule, is 
more common in children than the acute form, is 
associated with naso-pharyngeal catarrh, as is usually 
the case, Dr. A. JACOBI insists upon absolute clean- 
liness and washing out the nares regularly, several 
times daily, with a tepid solution, using : 



PHARYNGITIS. 99 

I£. Sodii chloridi . . . . 3 i. 

Aquae Oi. 

M. Sig. This amount once or twice daily. 

This, he directs, must be snuffed up the nose until 
it can be spit out through the mouth. The plan is 
usually very successful, and he considers it preferable 
to the nasal douche, which sometimes causes bad 
results and is objectionable. In addition to this, a 
kettle of boiling water is kept constantly in the room, 
where the child can breathe it continually. Where 
a medicated application is desired, he employs the 
nitrate of silver in mild solution of gr. ^-ii. — § i., 
according to the severity of the case. The stick or 
concentrated solution, however, he considers exceed- 
ingly dangerous, often setting up an incurable con- 
dition. As a rule, he uses : 

5. Argenti nitrat. gr. ss-i. 

Aquae . . . . . § i. 

M. 

This he injects twice a week, seeing that it enters 
the pharynx properly ; while, during the intervals, 
the child is instructed to attend carefully to the salt 
and water washing. 

Dr. Jacobi also calls attention to an elongated 
condition of the uvula, which, when the child lies 
down, falls backward and touching the posterior 
wall of the pharynx causes a sudden tickling, thus 



IOO PHARYNGITIS. 

keeping up a continual cough. This chronic state 
of things in the pharynx, he advises, if allowed to go 
on, results in dangerous consequences. The cough 
itself is a source of constant irritation, and eventu- 
ally sets up a catarrh in the trachea and bronchi. 
His treatment is to remove such an elongated uvula 
as soon as possible. If there is a choice, however, 
he directs that it should not be done when diph- 
theria is prevailing. 

Dr. A. H. Smith uses silver nitrate very effectu- 
ally, in certain cases, where there is a condition of 
naso-pharyngeal catarrh with muco-purulent dis- 
charge. As a preparatory measure, however, he first 
cleanses the parts thoroughly with a solution of so- 
dium nitrate; after which he employs the following, 
blown by means of the insufflator into the anterior 
and posterior nares: 

9- Argenti nitrat. gr. v. 

Potass, sulphat 3 iss. 

Bismuth, subnit. ad. . 5 i- 

M. Ft. pulv. 

Sig. To be used daily, or every other day. 

Dr. F. H. Bosworth cautions against permitting 
children to habitually breathe through the mouth, 
especially during sleep. This he believes to be a 
most prolific source of throat catarrh and bronchial 
disorders. In using inhalations, when the latter are 



PHARYNGITIS. IOI 

attended with much pain or irritation, he combines 
the following with evident satisfaction. 

^. Ext. hyoscyami . . . gr. v. 
Aquae § i. 

M. 

Dr. A. A. Smith prescribes the following with 
marked effect, in those cases of pharyngitis occurring 
in older children, and associated with dyspepsia : 

9- Ammon. chlorid. . . . 3 i. 

Tinct. cubeb. . . . $ ss. 

Tinct. gent, co 3 ss. 

Glycerinae ad . . . . § iv. 

M. Sig. A teaspoonful in water, every two or 
three hours. 

As a rule, Dr. Francis Delafield considers it 
best to begin with a purge, especially in pretty 
severe acute cases. For this purpose calomel is pre- 
ferred by him, combined with a moderate amount of 
opium to relieve and quiet the patient. Following 
this, he administers : 

1J. Tinct. aconit. rad. . . gtt. i-ii. 

Liq. ammon. acetat. ... 3 i-ii. 

M. Sig. Dose, every one or two hours, accord- 
ing to age. 

The local measures adopted by him consist, at the 
commencement, in the application oiice to the throat, 
or the use of vapor or spray by the atomizer. The 



102 VOMITING — DYSPEPSIA. 

simple vapor of steam is used, or this is sometimes 
modified by the addition of vinegar to the water, 
tincture of cubebs, or other remedies. Hot compresses 
are also applied externally. After two or three days 
he resorts to astringents, in the form of gargles and 
sprays of alum or borax ; or zinc sulphate, tannic acid, 
and potassium chlorate are also used at times, either 
of which, he finds, act very well in the later stages. 

Dr. G. M. Lefferts considers the following very 
efficient when a sedative gargle is desired : 

Ijfc. Potass, bromidi . . . 3 iss. 

Glycerinae 3 ii- 

Aquae §x. 

M. 

When an astringent is called for, he finds the fol- 
lowing very serviceable : 

9- Aluminis . . . . 3 i. 

Acid, tannic. . . . . 3 L 

Aquae . . .... § x. 

M. Sig. Gargle. 



VOMITING— DYSPEPSIA 



Dr. J. Lewis Smith uses the following with 
marked benefit, in relieving the nausea accompany- 
ing intestinal trouble in infants : 



VOMITING — DYSPEPSIA. 103 

9. Afcid. carbol gtt.ii. 

Aquae calcis . " . . . § ii. 

M. Sig. A teaspoonful. 

This he directs to be taken in a teaspoonful of 
milk, using breast milk if the baby nurses, and re- 
peated according to the nausea. 

At the Infants' Hospital the following is very 
extensively used : 

9. Bismuthi subcarb. 

Pepsini aa gr.ii. 

M. Sig. Dose. 

Dr. A. H. Smith (also Dr. G. B. Fowler) has 
found beef peptone of excellent service in these cases. 
Where the infant refuses to nurse, followed by per- 
sistent vomiting, with probably diarrhoea, he gives 
gtt. x. of beef peptone, properly diluted, every two 
hours ; at the same time stopping all other food and 
medication. This amount is, as a rule, gradually in- 
creased during the week. • Its administration is al- 
most invariably followed by improvement within a 
day or two ; the vomiting and diarrhoea speedily and 
entirely cease, and the child soon regains its lost 
health and strength. Also in cases of dyspepsia of 
long standing, where the slightest indiscretion in re- 
gard to food is followed by a period of great suffer- 
ing, and the usual remedies fail to give relief, beef 
peptone, in small doses at first and then gradually 



104 VOMITING — DYSPEPSIA. 

increased to teaspoonful doses every three hours, af- 
fords more benefit and cuts short the attack quicker 
than anything else. In fact, it is found to be uni- 
formly successful in all these cases in improving nu- 
trition, and in being assimilable when all other foods 
are rejected. It may usually be given in water and 
sweetened to the taste ; but should the peptone be 
objected to on account of the pronounced flavor of 
meat, he often adds it to a simple broth with advan- 
tage, when it is generally taken very readily. 

In those instances, so frequently met with, where 
the child is nursing, and vomits or regurgitates its 
food, Dr. A. A. Smith finds the following, in his ex- 
perience, of excellent service in relieving this condi- 
tion : 

9. Hydrarg. chlor. mit. . . . gr.i. 
Aquae ..... Oi. 

M. Sig. A teaspoonful every ten or fifteen min- 
utes. 

In preparing this, he advises that in tfrder to dis- 
solve it the calomel should first be added to aquae 
calcis § i, and then to a pint of pure water. Or, when 
the vomiting is accompanied with mucous discharge, 
he gives the following with good effect : 

5- Hydrarg. chlor. corros. . . gr.ss. 
Aquae Oi. 

M. Sig. A teaspoonful every fifteen minutes. 



VOMITING — DYSPEPSIA. 105 

In those cases of vomiting due to indigestion, com- 
monly found in young children, he gives : 

IjL Vini ipecac gtt.i. 

Aquae ..... q. s. 

M. Sig. Dose, even* ten or fifteen minutes. 

This he finds of the greatest benefit, and advises 
that it will often arrest the most obstinate vomiting, 
as well as any diarrhoea that may be present ; and, 
moreover, when administered in this manner, the 
drug is not in the least nauseous and is easily taken. 

In other instances, associated with a simple non- 
inflammatory diarrhoea, Dr. Smith prescribes 
Jiydrarg. cum cretcz, gr. 2 \ every fifteen or twenty 
minutes. This he recommends with much satisfaction 
in relieving this often exceedingly troublesome 
condition. 

Many cases of nausea and vomiting in children are 
also promptly and thoroughly relieved by the use of 
hot water. This is found to be especially useful in 
cases where these symptoms are purely reflex, and in 
the colic of newly born infants. 

Dr. W. A. Hammond uses the following very suc- 
cessfully, in the dyspepsia occurring in older chil- 
dren and dependent upon nervous causes : 

5- Sodii bromid. . . , . 31. 

Pepsin, citrat. .... 
Pulv. carbon. . . . . aa ~ iii. 



106 GASTRITIS. 

Aquae § iv. 

M. Sig. A teaspoonful or less, according to age, 
three times daily. 

Dr. F. Delafield prescribes the following, which 
is a favorite with him, in cases of dyspepsia in older 
children : 

5- Pepsini gr. iii-v. 

Pulv. cubeb. gr. v-x. 

Bismuthi subnit. gr. v-x. 

M. Sig. Dose. 



GASTRITIS. 



In the acute catarrhal gastritis of infants, in mod- 
erately severe attacks, Dr. F. DELAFIELD frequently 
finds that simply diminishing the food, and doing 
little or nothing else for twenty-four hours, will be 
all that is required. In severe cases, where there is 
high fever, he often employs sweating very service- 
ably ; placing the child in the hot bath for a few min- 
utes and then wrapping in a hot blanket. Small 
pieces of cracked ice may also be given at intervals. 
In many instances, however, he finds that the fever 
is of short duration, and calls for no treatment what- 
ever. To control the persistent vomiting, if the in- 
fant is brought up on the bottle, he gives sodii bi- 



GASTRITIS. I07 

carbonas with milk ; or if the child is nursing, he ad- 
ministers milk with the bicarbonate of sodium in ad- 
dition to its ordinary food ; in either case giving 
sodii bicarb, gr. iii-iv. in § ss. of cream and milk, or 
at times using sugared water. In other cases he em- 
ploys the following method of administration very 
effectually : 

9- Sodii bicarb. . . . . 3 i- 

Cremor. lactis 
Aquae aa § iv. 

M. Sig. A teaspoonful, to be taken every hour 
whether retained or not. 

Sometimes, however, he obtains excellent results 
from calomel, in small doses of gr. -fe-ss. 

In children over three years of age he substitutes 
milk for the water in the mixture, and gives double 
the dose, feeding the child on this alone while the 
attack is going on. Or, often he finds that brandy 
in small doses is very serviceable. To relieve the 
pain, which is usually prominent in these older chil- 
dren, he applies anodyne poultices, or sometimes tur- 
pentine stupes, with good effect, and, as a rule, admin- 
isters small doses of Dover's powder, just sufficient 
to diminish the pain. Where morphia is used for 
this purpose, he advises that it should be given by 
the stomach, usually beginning with m. ii. 



io8 



ENTERALGIA — ENTERITIS. 



ENTERALGIA (Colic)— ENTERITIS. 



Dr. J. W. McLane prescribes the following with 
very gratifying effect in the colic of babies : 



9 



Chloral, hydrat 
Sodii bicarb. 
Potass, bromid 
Aquae rosae 



. aa gr. vi-vni. 
• • • SL 

M. Sig. A teaspoonful, repeated every half-hour 
as required. 

In many cases, however, he prefers to use mint 
water — not peppermint, but green mint — in the above 
formula, instead of aqua rosae. 

Dr. F. A. BURRALL recommends the following as 
an excellent carminative for infants : 

Ijfc. Tinct. valerian, ammon. . . 3 ii. 

Lactopeptin. gr. xxxii. 

Sodii bicarb. ... gr. xii. 

Glycerinae . . . . 3 ii. 

Aquae . . . . 3vi. 

Aquae aurant. flor. . . . 3 i. 

M. Sig. M. xx-lx. in 3 1 — ii- of warm water as 
needed. 

This he has found to be an exceedingly valuable 
combination, where it is desirable to avoid an opiate. 



ENTERALGIA — ENTERITIS. IO9 

As a rule, in cases of spasmodic colic, Dr. Austin 
Flint pays little or no attention to the cause of the 
attack or to the presence of constipation ; but directs 
his treatment to the relief of the spasm, especially by 
the use of opiates, believing that so long as the spasm 
exists cathartics are of little or no avail. 

Dr. A. A. Smith considers the following very 
efficacious in relieving an attack of colic depend- 
ing on flatulence : 

^. Spts. chloroformi . . . J ss - 

Tinct. cardam. co. 3 ii. 

M. Sig. M. xv-xxx. in a tablespoonful of water, 
every half-hour until relieved. 

Dr. F. H. Hamilton finds that opium does not 
always cure an attack of colic. His later experience 
has been that this affection is most quickly and most 
permanently relieved by a full dose of some aromatic 
and stimulating cathartic, such as tincture of rhubarb 
with ginger. In certain cases, however, he finds that 
only a full dose of some active sedative will succeed. 
But he places greatest reliance on the mechanical ef- 
fects of posture (regarding displacement or doubling of 
the gut as the cause, at least in the majority of cases, 
rather than spasm or fecal obstruction), not, how- 
ever, as a positive cure for all cases, nor as a substi- 
tute for any other suitable mode of treatment ; but 
particularly as a supplement to other means, and 



no 



ENTERALGIA — ENTERITIS. 



which may sometimes prove effectual, or at least 
useful. In older children, he directs that the patient 
be made to assume a position elevating the hips with 
pillows, or over the end of a sofa. Occurring in in- 
fants, he advises that a similar position be secured, 
or that the child be raised by the feet as if in the act 
of applying a diaper; thus elevating the lower part 
of the body so as to cause the heavy organs, such as 
the liver and spleen, to fall toward the head, dragging 
the intestinal viscera with them. By this means, Dr. 
HAMILTON often finds that there is an almost imme- 
diate discharge of gas from the rectum, and, in in- 
fants, often a free fecal evacuation, with the effect of 
prompt and complete relief of the colic. 

-At the Infants' Hospital the following is con- 
stantly employed: 

1$. Infusi anisi ( 3 ii-Oi.) 

Genevse. . . . . aa§i. 

M. Dose : Half a teaspoonful. 

At the New York Hospital the following com- 
bination is considered to be highly valuable as a 
carminative : 

IJ. Tinct. opii .... gtt. xx. 
01. anisi 



Ol. caryophyl. 
Ol. gaulth. . 
Tinct. asafcetid. 



aagtt.ii. 
3i. 



ENTERALGIA — ENTERITIS. 1 1 1 

Magnes. carbon. . . . . 3 i- 

Aquae menth. pip. . . § iii. 

M. 

In cases of nursing infants, where after taking 
milk there follows a colicky condition, with griping 
pains, etc., the following mixture is found by many 
to afford speedy relief to these often frequent and 
exceedingly annoying attacks : 

5. Potass, carbon. . . . gr.ii. 

Ol. cajuput. .... m.i. 

Aq. anethi . . . . 3 ii. 

M. Sig. Dose, three or four times daily. 

In pure enteritis, Dr. F. Delafield advises the 
importance of an early diagnosis, since the treatment 
varies greatly from that of peritonitis, with which it 
is sometimes apt to be confounded. He first admin- 
isters a purge, usually preferring a full dose of castor 
oil ; or calomel, gr.ii-vi. in three divided doses one 
hour apart, adding also a little Dover's powder to the 
calomel. After this, and during the first day or two 
of the disease, he finds the use of opium to relieve 
the pain, very advantageous, but directs that this 
must not be continued after the fever has much di- 
minished, even though the pain persists, as, opium 
then is apt to make matters worse. During this 
early period he advises that the diet be regulated as 
near to nothing as possible, usually consisting of 



112 DIARRHCEA. 

milk, until the fever has subsided. After the first 
twenty-four or thirty-six hours, he places the patient 
on small and gradually increasing doses of ipecac ; at 
this stage of the disease, also, he orders a diet of beef- 
tea for a few days, followed after a while by the more 
ordinary articles of food, avoiding starches and milk. 



DIARRHCEA. 



In infantile diarrhoea due to indigestion and at- 
tended by acidity, Dr. J. Lewis Smith finds the 
following very effective : 

Ijfc. Pulv. ipecac. . . . . gr. ss. 
Pulv. rhei . gr. ii. 

Sodii bicarb. . . . gr. xii. 

M. Div. in chart. No. xii. 

Sig. One powder every four to six hours, to an 
infant one year old. 

In a large majority of cases, however, he employs 
the following combination. If it fails to relieve, and 
the regimen has been carefully attended to, he con- 
cludes that in all probability there is inflammation of 
the intestinal mucous membrane. 

]pfc. Tinct. opii deodor. . . gtt. xvi. 
Bismuthi subnit. . . . . 3 ii- 



DIARRHCEA. 113 

Syrupi simp. . . . 5 ss « 

Mist, cretae .... § iss. 

M. Sig. A teaspoonful every three or four hours, 
to an infant of one year. 

For the simple diarrhoea occurring in older children 
he generally gives : 

§,. Bismuthi subnit. . . . gr. xxx. 
Cretae praecipit. gr. xxx. 

Pulv. opii .... gr. i. 

M. Div. in pulv. No. x. 

Sig. One powder every three or four hours, as 
required. 

In giving bismuth to children, Dr. E. G. Janeway 
calls attention to the mode of administration. He 
finds that it is very common for the physician to 
direct that it be taken in water or milk, and it is 
noticed by the mother or nurse that the drug sticks 
to the bottom of the spoon, and makes the child gag 
in swallowing it. Therefore, in young children, he 
advises that it is not best to give bismuth in large 
doses, and to administer it with something which will 
hold the powder in suspension ; some mucilaginous 
material. He also directs that the mother be in- 
structed as to the effect of the drug on the color of 
the passages, and to the disagreeable odor which is 
sometimes present from the fermentation of the 
8 



ii4 



DIARRHCEA. 



mucus ; thus avoiding unnecessary and often serious 
alarm. 

Dr. A. A. Smith recommends the following as 
very serviceable in cases of diarrhoea dependent upon 
intestinal irritation : 

5-. 01. ricini .... gtt. v. 

Sacchar. .... q. s. 

M. Sig. Dose, to be given every two hours. 
He also uses the wine of ipecac, in doses of gtt. i. 
every ten or fifteen minutes, with excellent effect in 
arresting diarrhoea due to indigestion ; this he finds 
particularly useful where there is also vomiting 
present, and advises that when given in this manner, 
the drug is easily taken and has not the slightest 
nauseating effect. Hydrarg. cum cretce, gr. } T every 
fifteen minutes, is also recommended by him in cases 
of simple diarrhoea associated with vomiting. In 
older children, where an anodyne and stimulant is 
indicated, he prescribes the following with much 
satisfaction : 

Ijfc. Spts. ammon. aromat. 
Spts. chloroformi . 
Tinct. camphorae . 
Tinct. opii deodor . . . . aa3ii 
Tinct. capsici . . . 3 i- 

M. Sig. M. x-xx. in a wineglass of water. 
In diarrhoea due to food, whether acting as a 



DIARRHCEA. 1 1 5 

purge or as an irritant, Dr. F. DELAFIELD usually 
controls it by the use of castor oil, or sometimes rhu- 
barb. Where, however, the irritation and passages 
continue, he administers opium, either alone or with 
bismuth or bicarbonate of sodium. In the diarrhoea 
of young children which commonly occurs in hot 
weather, he finds that the mildest of these cases 
hardly need any treatment at all ; or he sometimes 
gives : 

9. 01. ricini . . . . 3i-^ss. 

Tinct. opii .... gtt. ii-iv. 

M. Sig. Dose, according to age. 

Should the attack continue, he then considers it 
unwise to use purgatives. The indication is to re- 
lieve the irritant condition of the intestine, to ac- 
complish which he administers opium, as above, in 
very small doses, generally using Dover's powder or 
paregoric. This, also, he finds is best combined with 
small doses of ipecac, or rhubarb, thus : 

9- Tinct. opii .... gtt. iii-iv. 
Pulv. ipecac gr. \. 

M. Sig. Dose, every three or four hours. 

Or, pulv. rhei, gr. % is given instead of the ipecac. 
He further directs that the child be kept quiet and 
in a cool place, avoiding fruits and feeding on milk 
and starches. 

The following mixture is found by many to be a 



n6 



DIARRHCEA. 



valuable prescription in cases of non-inflammatory 
diarrhoea, where there is not much pain or tenesmus, 
and where the evacuations, though watery, are fecal 
and contain but little mucus : 

5- Magnes. sulph. . . . 3 i. 

Tinct. rhei 3 ii. 

Syrup, 'zingib. . . . . 3 i. 

, Aquae carui . . . . 3 x. 

M. Sig. A teaspoonful three times daily, to a 
child of one year. 

At the Infants' Hospital the following is very 
considerably employed : 

5. Bismuthi subcarb. . . . gr. ii. 

Acidi tannici .... gr. i. 

Pulv. ipecac, co. gr. }£. 

M. Sig. Dose, repeated as necessary. 
At the Hart's Island Hospital (child's), the 
following diarrhoea mixture is kept constantly on 
hand, and is considered to be a most excellent com- 
bination : 

]J. Tinct. capsici 
Tinct. catechu 
Tinct. kino 
Tinct. krameriae . . . . aa § iv. 

Tinct. opii ...... g iii. 

Spts. menth. pip. ... 3 ii. 



DIARRHOEA. 



117 



Spts. camphorae . 
Aquae .... 
M. Dose : M. xxx. 


. aa 3 iv. 


At Bellevue Hospital, the following are used 


ith much satisfaction : 




9. Tinct. opii camph. 
Syrup, rhei arom. 
Aquae calcis 


. aa 3 ss. 
3 ii. 


M. Dose: A teaspoonful. 
Or: 




p. Hydrarg. cum cretae 
Pulv. bismuth, subnit. 


• gr. #• 


Pulv. pepsin. . 
M. Sig. Dose. 


. aa. gr.iii. 


Also: 




Ijfc. Tinct. opii .... 
Tinct. rhei arom. 




Spts. camphorae 
Tinct. cardam. co. 


. aa 3 ss. 
3 ii. 


Aquae anisi q.s. ad 


5iv. 



M. Dose : A teaspoonful. 

For the administration of castor oil, the following 
combination is rendered exceedingly palatable, and 
is readily taken by children : 

9. Pulv. gum. acac. . . . %i. 

Syrupi 

Glycerinae aa§i. 



Il8 INTESTINAL CATARRH. 

Aquae § iii. 

01. ricini Jvi. 

Ext. vanillae .... 

Spts. vini gall aa 3 ii. 

01. cinnam. ver. . . . m.v. 

M. Dose: Double the quantity of oil intended to 
be given. 



INTESTINAL CATARRH. 



In cases of diarrhoea with intestinal catarrh in in- 
fants, when due to improper food which has not been 
digested and thus acts as an irritant, Dr. A. JACOBI 
places the child on a diet of milk, diluted one-half or 
less with gum arabic water, or barley water. This 
dilution he considers very important in the treat- 
ment. Also, to prevent coagulation of the milk by 
the over-acid stomach, he adds an antacid ; avoiding 
the sodium and magnesium salts, on account of their 
purgative action, and giving calcium carbonate in 
doses of gr. iii. In some instances, and especially in 
bad cases occurring in the summer time, he finds 
that cow's milk is not digested at all. He therefore 
.prohibits its use at once, and gives barley water 
alone, or substitutes the white of egg for the milk. 



INTESTINAL CATARRH. II9 

Or, if the diarrhoea is very marked, he forbids the 
milk altogether. This treatment, he advises, must 
be kept up for from one to two weeks, according to 
the previous duration of the catarrh. The diarrhoea, 
he directs, should be checked at once to avoid its 
injurious effects on the abdominal glands. If there 
is still any irritant substance in the intestine, he 
administers a dose of castor oil, 3 i. given in hot milk. 
This is usually efficient. 

For local measures, to act on the inflamed mucous 
membrane, he considers bismuth superior to other 
remedies, as it acts not only as a protection to the 
inflamed surface, but also, at the same time, as an 
anti-fermentative. He generally gives it in combi- 
nation with opium, to check the undue amount of 
secretion and peristaltic action ; thus : 

9 • Bismuthi subnit. . . gr. ii-iii. 

Pulv. Doveri. . . . gr. J. 

M. Sig. Dose, every three hours. 

Under this treatment, with careful attention to 
feeding, which he considers most important, the 
results are usually very satisfactory. 

When the 'diarrhoea is associated with chronic 
catarrh dependent upon ulceration of the intestine, 
Dr. JACOBI advises that treatment with astringents 
only is useless. In these cases the indications are to 
stop the diarrhoea, and heal the ulcerations. Lime 



120 INTESTINAL. CATARRH. 

has the effect of neutralizing the abnormal, and per- 
haps the normal acids, and now and then he finds 
that it does good ; but if given for a long time it is 
apt to cause obstinate constipation, hence care is 
advised as to the amount used. Bismuth, which 
acts as an anti-fermentative, he considers very ser- 
viceable. In children of six to twelve months of age, 
he gives: 

]pL Bismuthi . . . . gr. ii-iii. 

P n ' g. tjWo- 

M. Sig. Dose, every three hours. 

In some instances he also prescribes : 

9. Argenti nitrat. . . . gr. -^Wo- 
Aquae 3 i. 

M. Sig. Dose, every two hours. 

Care must be exercised about giving astringents, 
as these young children must also take milk. 

As regards the diet, this he believes to be a matter 
of the greatest importance. In many cases where 
milk cannot be digested, he advises that the patient 
be made to eat the milk by spoonfuls, not to drink 
it ; and to add to it a little common salt, as by this 
means it is made more like mother's milk which 
contains more sodium than cow's milk. When, 
however, cow's milk cannot be tolerated at all, he 
directs that it be mixed with some glutinous sub- 
stance, so that it can be acted on very slowly by the 



INTESTINAL CATARRH. 121 

• 

gastric acids ; usually ordering one-third to one-tenth 
of cow's milk, after having boiled it, to be mixed 
with barley water, the latter also being boiled alone 
for twenty minutes. If cheesy matter is still found 
in the passages, he omits the milk altogether, and 
gives one or two whites of egg with barley water in 
twenty-four hours. On this plan, he generally ad- 
ministers about one-half pint of milk, three pints of 
barley water, one white of egg, and with this a tea- 
spoonful of brandy, during the twenty-four hours. 

In cases of protracted diarrhoea with chronic rectal 
catarrh, where prolapsus occurs after every act of 
defecation, and the mucous membrane is swollen 
with more or less hypertrophy of the part, Dr. 
JACOBI finds the following ointment of rare service : 

]J. Ext. nucis vomicae . . pars i. 

Adipis part. xx. 

M. 

Finally, he calls attention to the fact that young 
children with catarrh of the colon and follicular 
colitis, are very apt to have a dilated colon ; and in 
these dilated artificial diverticula masses of fecal 
matter are retained, the serum is absorbed, and in 
this way the hard feces form, resulting, after a time, 
in paralysis of the colon and perhaps of the rectum 
and sphincter. 

Dr. J. JLewis Smith prescribes the following with 



122' INTESTINAL CATARRH. 

much satisfaction, in the intestinal catarrh of infants 
where the nausea is extreme : 

9- Acidi carbol gtt. ii. 

Aquae calcis . . . . § ii. 

M. Sig. A teaspoonful. 

This he directs should be taken with a teaspoonful 
of milk, using breast milk if the baby nurses, and 
repeated as often as the nausea requires. Where the 
disease has passed into the chronic stage, he admin- 
isters tonics, etc., and advises the most careful atten- 
tion to feeding and hygiene. For a tonic in 
these cases he gives the following with marked ben- 
efit: 

1$. Tinct. calumbae . . . 3 iii. 

Liq. ferri nitratis . « . gtt. xxvii. 
Syrup, simplic. . . . . § iii. 

M. Sig. A teaspoonful every four hours, to an 
infant of one year. 

This he finds especially valuable where there is 
much pallor, loss of strength, and emaciation, show- 
ing failure of the vital powers. 

In cases of diarrhoea where no history of weather 
influences exists, and with vomiting and considerable 
fever, Dr. F. Delafield gives sedatives at once, 
using opium either alone or with bismuth, ipecac, or 
sodii bicarb. ; often prescribing the following : 

1$. Pulv. Doveri ... gr. ss-i. 



INTESTINAL CATARRH. 1 23 

Bismuthi subnit. . . gr. iii-iv. 

M. Sig. Dose, every three or four hours. 

Or, ipecac, gr. -§-, or rhei, gr. J, is sometimes substi- 
tuted for the bismuth in the above combination. In 
some instances, however, where although the child 
improves, yet it does not entirely recover, and the 
disease becomes protracted, he advises that it is use- 
less to persist with the opium treatment after a 
moderate time. In these cases he directs that a 
change of air be obtained, which alone will often 
effect a cure. Where this is not sufficient, he then 
administers hydrarg. cum cretce, gr.ss. two or three 
times daily, for three or four days, and usually with 
very marked benefit. Or, he frequently gives calo- 
mel gr. %-ss. in the same manner. 

Regarding diet in these protracted cases, if the 
child is nursing he sometimes allows it to continue, 
or may change the nurse, or try hand-feeding ; vary- 
ing his course with the indications. If the child is 
fed with the bottle he generally changes the food, 
sometimes adding other articles, where the diet has 
been milk alone, or, in other instances, directing that 
the child be nursed. In other children, he usually 
obtains good results from feeding on raw meat, beef- 
steak scraped to a pulp, with a little salt added, and 
keeping this up for some time (avoiding a too long 
continuance, however, from danger of scurvy). 



124 INTESTINAL CATARRH. 

In the severest forms of the disease, where although 
the attack begins in a mild way, yet in spite of treat- 
ment the diarrhoea continues, assuming a dysenteric 
character, and the stools finally become of a starchy 
consistency, a whitish color, and at the same time 
more and more abundant, while the constitutional 
symptoms are extremely marked and emaciation 
rapid, Dr. Delafield proceeds as follows : In the 
milder forms he generally finds it best to commence 
with castor oil, thus : 

1$. Ol. ricini . . . . 3i-§ss. 
Tinct. opii .... gtt. ii-iv. 

M. Sig. Dose, according to age. 

This, in some cases, maybe sufficient. Should the 
movements continue for a time, he then administers 
opium with bismuth, as in other instances. If the 
disease still persists, the remedies which he finds 
most serviceable are the mineral acids, with opium ; 
more especially dilute hydrochloric acid, which he 
administers, at first, as follows: 

9. Acid, hydrochlor. dil. . gtt. x-xx. 
Tinct. opii . . . . gtt. i-ii. 

M. Sig. Dose, three or four times daily, accord- 
ing to age. 

As improvement takes place, he diminishes the 
opium, keeping on with the acid, until the child is 



INTESTINAL CATARRH. 1 25 

much better, when he stops the opium altogether, 
the acid, however, being still continued. 

For the diet, in these cases, Dr. Delafield finds 
that these children are best fed with cod liver oil and 
meat, and with as little starch as possible ; older 
children he places on a diet of cream and milk with 
meat or oil, while to very young children he gives 
cream and milk. If possible, he advises a change of air, 
as exceedingly beneficial, except in chronic cases. He 
also advises care in regard to the general manage- 
ment of the child, regulating the bath, clothing, etc. 

Dr. A. A. Smith often gives the following with 
advantage, in those cases where the diarrhoea is ac- 
companied by mucous passages, showing a slight 
degree of inflammation : 

9. Hydrarg. bichloridi . . gr. J. 

Aquae ..... J vl11 - 

M. Sig. A teaspoonful every hour. 

Where a more intense inflammatory action is 
present, with straining, and the passages consist of a 
jelly looking matter, but not truly dysenteric, he 
prescribes the following very effectually : 

9- 01. ricini .... gtt. v. 

Sacchari .... 

Mucilag. 
Aquae . . . . . aa q. s. 

M. Sig. Dose, every hour. 



126 DYSENTERY. 

This remedy, thus administered, he has found to 
render excellent service in many of these cases. 

At Bellevue Hospital the following form of 
combination for Dover s powder is very much used, 
and is considered preferable to the officinal powder : 
9- Pulv. opii (12 per cent.) 

Pulv. ipecac. aa gr. i. 

Sacchari lactis gr. viii. 

M. 



DYSENTERY. 



In catarrhal dysentery, Dr. Francis Delafield 
considers rest all important ; no matter if the con- 
stitutional symptoms are slight, or even absent, still 
he insists on the necessity of absolute rest. In milder 
cases this may be all that is necessary, and the dis- 
ease succumbs without further treatment. If seen 
early he usually begins with : 

9- 01. ricini .... 3i-iii. 

Tinct. opii .... gtt. iii-v. 

M. Sig. Dose. 

Where, however, the pain and irritation about the 
rectum continue, opium is given to control it ; either 
by the mouth in the form of bismuth and opium 
powders, or by the rectum in small enemata of 



DYSENTERY. 1 27 

starch and laudanum, or by suppositories. Regarding 
diet, this, he advises, needs careful regulation ; all solid 
food must be avoided and the child fed on milk, either 
alone or with starches, arrowroot, rice, etc. By this 
means, these cases usually terminate favorably. 

In croupous dysentery, if the case is seen at the 
onset, and in those resembling the catarrhal form, 
he generally administers ol. ricini and opium in suffi- 
cient doses to afford quiet and relieve the pain. 
After the first dose he often finds it necessary to give 
only the opium. In the more severe forms, however, 
after beginning with castor oil and opium, he then 
administers ipecac in large doses every one, two, or 
three hours, according to the severity of the disease 
and the patient ; at the same time giving opium in 
small doses. In three or four days he repeats the 
castor oil, following it with ipecac as before, and then 
falls back on opium. During this treatment the ol. 
ricini may have to be repeated several times, depend- 
ing upon the duration of the disease. Where the 
pulse becomes feeble, stimulants are given. After 
the inflammatory process has run its course, and 
ulcers are present, the castor oil and ipecac are dis- 
carded, and the dilute mineral acids resorted to ; or 
suppositories of iodoform are used with good effect. 
Stimulants are also employed at this stage, and the 
strength of the patient supported with good nour- 



1 28 DYSENTERY. 

ishment, etc., the diet consisting of arrowroot, rice, 
and milk. 

Where the disease tends to become protracted, 
Dr. DELAFIELD advises especial care regarding rest 
and diet. A strictly milk food he finds particularly- 
serviceable in the catarrhal form. Moderate stimu- 
lation is also employed, and a very gradual return 
made to the ordinary diet. For the general health, 
he administers tonics, iron and quinine, and advises a 
change of residence to a warm climate, together with 
plenty of fresh air. 

As a rule, in most instances, Dr. J. Lewis Smith 
finds that marked improvement is often derived from 
administering the following : 

9- Pulv. ipecac, co 3 i. 

Bismuth, subnft. . . . . 3 ii. 

M. Div. in pulv. No. xxiv. 

Sig. One every two to four hours, to a child 
of five years. 

In conjunction with this, he also gives : 

9- Tinct. opii deod. . . . 3ss. 

Bismuthi subnit. . . . 3 ii. 

Aq. menth. pip. .... 

Syr. zingib. . . . . aa^i. 

M. Sig. A teaspoonful, every two to four hours. 

Besides this means of treatment, he directs that 
the most careful attention be paid to diet, etc. 



DYSENTERY. 1 29 

Dr. G. B. Fowler (also Drs. A. H. Smith and 
LORDLY) has employed beef peptone, in cases of acute 
dysentery, with remarkable effect. Under the use 
of this remedy the results have been exceedingly 
good ; the distressing symptoms subside, the vomi- 
ting and stools are speedily controlled, nutrition is 
markedly improved, and the child soon begins to re- 
cover its health and strength. The administration 
is usually commenced with gtt. x. of 'beef 'peptone every 
two hours, and then gradually increased to doses of 
3 i. every two or three hours, to infants of six months 
and over. He generally gives it in water, sufficiently 
diluted, and sweetened to the taste. Should, how- 
ever, the strong taste of meat be objected to, it is 
often added to a simple broth, and in this way 
readily taken. Moreover, as a diet, in these cases, 
he has found peptone to be assimilated w r hen all 
other foods are rejected. 

In older children, Dr. Alonzo Clark uses the 
following with much advantage : 

5- Bismuth, subnit. gr. v. 

Morphiae sulph. . . gr. -£$. 

M. Sig. Dose, two or three times daily. 

By this means he often obtains relief in these 
cases ; advising, also, that the influence of proper 
diet and surroundings must receive careful atten- 
tion. 

9 



130 CHOLERA INFANTUM. 

At Bellevue Hospital the following mixture is 
employed : 

9. Acid, nitric m. viii. 

Tinct. opii .... m. xl. 

Aquae camphor. ... 3 viii. 

M. Dose : A tablespoonf ul or less, according to age. 



CHOLERA INFANTUM. 

(spurious hydrocephalus.) 



In the earlier stages of the disease, Dr. J. LEWIS 
Smith finds that the following is often of great ser- 
vice : 

9. Tinct. opii deod. . . gtt. xvi. 

Bismuth, submit. . . . 3 ii. 

Syrupi § ss. 

Aquae ..... 3 iss. 

M. Sig. A teaspoonful every two or three hours, 
to a child of one year. 

When the vomiting and diarrhoea are excessive 
and peristent, so that no food is retained, he uses 
the following with marked benefit : 

9. Spts. ammon. aromat. . . 3 ss-i. 

Tinct. opii .... gtt. xvi. 



CHOLERA INFANTUM. 131 

Bismuth, subnit. . . . 3 ii- 

Mistur. cretse .... § iss. 

Syrupi simp. . . 5 ss. 

M. Sig. A teaspoonful every two or three hours, 
to a child of eight to twelve months. 

This he continues, as directed, until these symp- 
toms are fully controlled. Stimulants are also ad- 
ministered as required. When the hydrocephaloid 
stage is reached, he gives the following with advan- 
tage : 

5. Tinct. calumbae . . . 3 ii. 

Liq. ferri nitratis . . gtt. xviii. 

Syrupi ..... 3 ii. 

M. Sig. A teaspoonful. 

On this plan, together with the most careful at- 
tention to diet, etc., his results are often very favor- 
able. 

At the New York Foundling Asylum the 
lirdrobromide of cinckonidia, by hypodermic injec- 
tion, has been employed in numerous instances of 
cholera infantum, and usually with the most satisfac- 
tory results. In many cases with high temperature, 
and profuse diarrhoea and vomiting, this remedy has 
afforded relief in a very short time. The injection, 
it is advised, should be repeated at least once, if not 
twice, in the twenty-four hours. A ten per cent, 
solution is generally employed, and small doses of 



132 CHOLERA INFANTUM. 

carbolic acid given internally in conjunction, with 
also cold baths and stimulants as required. By this 
method, also, not only a speedy action of the remedy 
is obtained, but any disturbance of the stomach is 
avoided, as well as a liability to the production of 
abscesses, which not infrequently results when quin- 
ine is employed in this manner. After the vomiting 
has ceased, the good effects of the remedy are main- 
tained by administering it by the mouth. 

The following case will exemplify : 

JULY 29th. — Infant, two months old. Has 
diarrhoea and vomiting ; sick twenty-four hours ; 
passages green and watery ; vomits greenish fluid. 
Temp. 104!° * n t ne rectum. Administered sol. cin- 
chonid. hydrobrom..{ten per cent.) in. viii. hypodermi- 
cally over the nates. Ordered, in conjunction with 
the above, the following : 

9. Acid, carbol. . . . gtt. \. 

Tinct. opii deodor. . . gtt. f . 

Mist, cretae .... 3 i. 

M. Sig. Dose, every two hours. 

Cold baths given every three hours. Brandy and 
toast-water as a drink. 

Aug. 5th. — Bowels improved. Vomiting checked. 
Temp I02|° in the rectum. Gave cinchondice hydro- 
brom. gr. i. four times daily, by the mouth. After- 
ward, the case did well. 



CHOLERA INFANTUM. 1 33 

Dr. Francis Delafield finds that treatment of 
any kind is very unsatisfactory. Regarding the 
diet, if the child is nursing he usually allows it to 
continue, or in some cases he may change the nurse, 
or try hand feeding. Where, however, the child is 
bottle fed, he sometimes changes the food or directs 
that a nurse be obtained ; but, as a rule, he finds 
that these cases do better with cream and water, or 
wine whey in small and very frequent doses. If 
vomiting is excessive so that all nourishment is re- 
jected, inunctions of oil, olive or cod liver, are re- 
sorted to very effectually when other means fail. 

For internal medication he knows of no 
remedy which, in his experience, has any very de- 
cided effect on the disease. Opium is given in small 
doses, and though it may not have much effect in 
checking the disease, yet it is of service in allaying 
the irritation of the child. In some cases he finds 
that calomel in doses of gr. ^-i. three or fotir times 
daily, according to age, or mercury with chalk simi- 
larly given, seems to be very serviceable in checking 
the disease. In others, ol. ricini is given, not to act 
as a purge, but in small and frequent doses, a few 
drops in emulsion every three or four hours, and 
often seems to act very beneficially. Other remedies, 
such as the preparations of bismuth, dilute hydro- 
chloric acid, or dilute sulphuric acid, are also used in 



134 



CONSTIPATION. 



different instances. Dr. Delafield considers it 
best, however, in all cases of cholera infantum, to 
send the child to some other climate, and the earlier 
the better. Nor in this respect, he advises, should 
there be any hesitation, even through prostration is 
so great that the child is apparently moribund. 

After the acute symptoms of the disease have sub- 
sided, the following combination is often found re- 
markably beneficial : 

~fy. Argenti nitrat gr.i. 

Acid, nitric, dil. . . . m.viii. 

Tinct. opii deodor. . . m.viii. 

Mucilag. acaciae . . • . § ss. 

Syrup, simp. . . ; . § ss. 

Aquae cinnamomi . ; , § i. 

M. Sig. A teaspoonful every three to six hours, 
to a child of one year. 



CONSTIPATION. 



Dr. A. JacOBI finds that young children with ca- 
tarrh of the colon and follicular colitis, are very apt 
to have a dilated colon ; and in these dilated arti- 
ficial diverticula masses of fecal matter are retained, 



CONSTIPATION. 1 35 

the serum is absorbed and in this way the hard feces 
form, resulting after a time in paralysis of the colon 
and perhaps of the rectum and sphincter. In such 
cases of constipation, with paralysis of the sphincter 
ani and incontinence of feces, the discharges being 
hard and black, where no abnormal irritability of the 
intestine exists, he directs his treatment toward re- 
storing the power of the sphincter. The general 
measures adopted by him, consist in the administra- 
tion of nerve stimulants and tonics, such as strychnia. 
Locally, he resorts to the use of strychnia, applying 
after each act of defecation an ointment of the fol- 
lowing; 

R. Ext. nucis vomicae . . gr. xii. 

Adipis 3 iii-iv. 

M. 

Or, he often uses the sulphate of strychnia hypo- 
dermically, thus : 

5- Stryahniae sulph. . . . gr.gV 

Aquae ..... q.s. 

M. Sig. To be injected once daily. 

He also employs the galvanic and faradic currents, 
using them alternately once a day. In addition to 
these means of treatment, he directs that injections 
of cold water be administed twice daily. 

Regarding the diet, if there is also intestinal ca- 
tarrh present, this is considered of the greatest im- 



136 CONSTIPATION. 

portance. When milk is poorly digested, or not all, 
he directs that a little salt be added and the child be 
made to eat the milk, a spoonful at a time, instead 
of drinking it. Should even this be rejected, he finds 
that it may be retained by adding to the milk some 
glutinous substance, thus causing it to be acted upon 
very slowly by the gastric acids. In such cases, he 
usually gives very successfully a mixture of one-third 
to one-tenth of cow's milk, previously boiled, with 
oatmeal water, after boiling the latter alone for twenty 
minutes. 

Dr. JacOBI also calls attention to the fact that the 
size of the colon and its sigmoid flexure, as well as 
the number of its flexures, does not obtain its nor- 
mal relation until from the fifth to the eighth year of 
life. In these flexures accumulations of feces often 
take place. Where this state of things exists, the 
secretion of the intestine is usually insufficient, caus- 
ing a dryness of the feces resulting in constipation. 
Therefore constipation depending upon an abnormal 
length of the sigmoid flexure, and the presence of a 
number of flexures, will wear off, and is not amenable 
to treatment by purgatives, which, if used, may cause 
a paralysis of the sphincter ; hence he advises that 
these should never be employed except in very urgent 
cases. When such a condition is suspected, he reg- 
ulates the diet so that there may be an abundance of 



WORMS. 137 

water in the food. For a food, he gives oatmeal in 
preference to any other. His main treatment, how- 
ever, in these cases, consists in the regular daily use 
of injections into the bowels. These, he advises, are 
highly beneficial, but may have to be continued for 
many months ; as the constipation, being anatomical, 
may not disappear until the cause is removed. He 
directs, therefore, that the intestine be washed out 
with simple warm water, day after day, while waiting 
for nature to restore the proper proportion of the in- 
testinal canal. In obstinate cases he sometimes re- 
sorts to the use of the scoop. 

Dr. A. A. Smith recommends the following very 
highly, in cases of constipation in children, as an ex- 
ceedingly pleasant and efficacious laxative : 

5- Ext. rhamni frangulae fl. . ■ 31". 

Aquse menth. pip. . . . 31. 

M. Sig. One to two teaspoonfuls, to a child from 
two to eight years of age. 



WORMS. 



For the expulsion of the round worm, Dr. J 
LEWIS SMITH uses the following very effectually : 



138 WORMS. 

I£. Ext. spigelian fl g i. 



Ext. sennae fl. 



ss. 



M. Sig. A teaspoonful, to a child of three to 
five years. 

Or, in many cases he prefers to give the following, 
which he considers equally serviceable : 

I£. Ext. spigelian et sennae fl. . . 3 i. 

Santonini . . . . . gr. viii. 

M. Sig. A teaspoonful, to a child of five years. 

Moreover, he finds that these prescriptions are also 
an effectual means of destroying the ascaris vermicu- 
laris. 

For the removal of the tcenia solium, Dr. Smith 
often uses the ethereal extract of male fern with ex- 
cellent results. In many instances he administers : 

1$. Ext. filicis mar. aether. . . 3 i. 

Sig. Dose, to a child of four years. 

This amount he is in the habit of giving to these 
young children, and has never seen any bad effects 
follow. In regard to the frequent failure in efficacy 
of this drug in taenia, he believes this is due to the 
fact that the dose prescribed was not large enough, 
and the patient had not been previously put upon 
the preparatory treatment which is so essential. 

Dr. A. Ja^OBI advises that in many cases the 
taenia found in very young children is the tcenia 
medio-canellata, caused by feeding the child with raw 



WORMS. 139 

meat as a remedy for diarrhoea ; and finds that their 
expulsion is far more difficult than of the taenia so- 
lium in adults. To accomplish this, he administers 
kameela powder, 3 i. in the course of two hours. Or, 
sometimes he prescribes kousso with good effect. 
Previous to this, however, he directs that the child 
be fed on oatmeal and milk, and purged three or four 
times daily. Then, after the administration of the 
kameela, a little milk is given, and if the worm does 
not appear in an hour, he orders a dose of castor oil. 
In his experience this plan is usually very success- 
ful. 

Dr. Van GlESEN has found the aspidium margi- 
nale — the indigenous congener of the male fern — 
very serviceable in causing discharge of the worm, 
and generally in a short time. This he gives as fol- 
lows : 

5. Ext.aspidiimarginal.fi. . . 3 ii. 

Olei olivse . . . . 3 iv. v 

iEther. sulphuric. . . ' . 3 ss. 

M. Sig. Half a teaspoonful every fifteen min- 
utes. 

After three or four doses have been taken, he ad- 
ministers a purge of castor oil. This remedy, he 
thinks, in not a few instances, has undoubtedly done as 
well as the male fern usually does. In a great many 
cases, however, he also uses the ethereal extract of 



140 INCONTINENCE OF URINE. 

filix mas in doses of m. xxx. to a child of two years. 
This amount he gives very effectually, and without 
any bad results. 



INCONTINENCE OF URINE. 



At BELLEVUE HOSPITAL the combination of ergot, 
belladonna, and iodide of iron is employed in a large 
number of cases, and proves more successful for the 
incontinence of urine in children than either of the 
drugs alone, or than any other combination which 
has been tried. 

In many cases the following is often found to be 
of excellent service, affording speedy relief to the ir- 
ritability of the bladder : 

5,. Strychnise .... gr. i. 

Pulv. cantharides . . gr. ii. 

Morphiae sulph. . . . gr. iss. 

Ferri pulv. . . . . 3i. 

M. Ft. pil. No. xl. 

Sig. One, three times a day, to a child of 
ten years. 

In conjunction with the above, a cold shower bath 
is usually given daily, and careful attention paid to 



INFANTILE LEUCORRHCEA. 141 

the avoidance of irritant food and late suppers. The 
child should also be made to lie on the side or belly, 
taking care to drink nothing for a few hours pre- 
ceding sleep, and to empty the bladder thoroughly 
before going to bed. 



INFANTILE LEUCORRHCEA. 



Dr. T. Gaillard Thomas considers it of pri- 
mary importance to ascertain if worms, usually the 
ascaris vermicularis, are present ; and if so, or should 
they be suspected, he uses an injection of warm salt 
water. He then endeavors to build up the general 
nutrition of the child, and place it in the best pos- 
sible condition, by appropriate food, iron, vegetable 
tonics, and the administration of the hypophosphites. 
He places more dependence, however, upon a good 
nourishing diet than upon medicines. After the ex- 
pulsion of the worms, should the irritation and dis- 
charge continue, or even if no worms have been 
present, he then resorts to local measures. Placing 
the child upon the back in order that the canal may 
be perfectly cleansed, he washes out the vagina 
thoroughly, by means of a syringe provided with a 



142 INFANTILE LEUCORRHGEA. 

small nozzle which has been previously well oiled. 
In many instances, he finds that the mere removal 
of the accumulated secretion, which is a constant 
source of irritation, is all that is required. Where, 
however, the trouble has lasted for some time, this 
is not always sufficient. In such cases he uses the 
old-fashioned black wash, as follows : 

I£. Hydrarg. chlor. mit. . . § ss-i. 

Aquae calcis ..... Oi. 

M. Sig. To be applied twice daily. 

This he believes to be one of the best applications 
that can be employed. Before using it, an injection 
of simple warm water is made. 

Under this treatment, Dr. THOMAS has never 
failed to cure infantile leucorrhcea in a short time ; 
therefore he advises against any necessity of resort- 
ing to astringents and silver nitrate, which may do 
harm. He also directs that the mother or nurse be 
instructed how to properly introduce the nozzle of 
the syringe, otherwise it is seldom carried far enough 
up into the vagina, while it should reach the 
upper part, and improvement will fail to follow its 
use. 

Dr. J. B. Hunter generally finds constitutional 
treatment and bathing of the external genitals suffi- 
cient. As a final resort, he recommends injections. 
In this respect, however, he objects to cold water 



INFANTILE LEUCORRHCEA. 143 

injections as injurious, having on many occasions 
seen bad results from their use. 

Dr. V. P. GlBNEY has frequently met with cases 
of sero-purulent vaginal discharge, in children of two 
to six years of age. In some instances he places the 
child upon the following, with much advantage : 

9. Calcii sulphidi . . gr. -fa. 

Sig. Dose, every three hours. 

If no benefit obtains in a few days, he orders warm 
and slightly carbolized injections. When indicated, 
he also prescribes iron and cod liver oil. Sometimes 
he finds this plan is very serviceable, while at others 
no benefit at all is apparently derived. 

Dr. Beverly Robinson is not inclined to ascribe 
so much importance to the condition of diathesis, in 
cases of leucorrhcea in children. Local treatment is 
considered by him as generally much more effectual. 
Moreover, in the treatment of vaginitis by injections, 
he thinks that cold injections probably have an ad- 
vantage over warm ones. 

At the New York Hospital this condition is 
found to be not infrequently associated with a 
strumous diathesis ; or, occasionally the urine ex- 
hibits the presence of a large amount of uric acid. 
In some of these cases local measures are adopted, 
although the propriety of this treatment is consid- 
ered as doubtful. 



PART IV. 

DISEASES OF THE BRAIN AND 
NERVOUS SYSTEM. 



CONVULSIONS. 



Dr. J. Lewis Smith considers the treatment of 
infantile convulsions one of the greatest importance, 
as these cases are so frequently met with without 
being able first to ascertain the cause. Ordinarily, 
regarding the seat of the disturbance as being in the 
intestine — either overloading or indigestible food — 
he first causes evacuation of the bowels. ' For the 
convulsion itself, when occurring in infants and de- 
pendent upon pain produced by the irruption of the 
teeth, he rarely or never uses the gum lancet. His 
reliance is almost wholly upon the bromides, prefer- 
ring the potassium salt in large and frequent doses, 
thus: 

Ijfc. Potass, bromidi . . gr. ii-vi. 



CONVULSIONS. 145 

Aquae q. s. 

M. Sig. Dose, every ten, fifteen, or twenty min- 
utes, to a child between two and twelve months of 
age. 

This he repeats as above, according to the severity 
of the case and to the control of the irritation, and 
he has never seen any bad results follow from this 
course. 

In the convulsions of children, his plan is to give 
chloral hydrate by rectal injection, combined with 
the internal use of the bromide, and if the spasms 
are not soon controlled he administers chloral hypo- 
dermically. He usually prescribes the following: 

9- Chloral, hydrat 3 i. 

Aquae § iss. 

M. Sig. 3 i- (gr- v.) every five or ten minutes, as 
an enema. 

By this treatment, if retained, he finds that the 
beneficial effect of the drug is often surprisingly 
shown, and its action readily and speedily exhibited. 
The convulsive movements are controlled in the 
shortest possible time, generally within twenty 
minutes, and in many cases in even a shorter period. 
He then continues the treatment with the bromide, 
if necessary. As to the administration of anaesthet- 
ics, that is to say of chloroform, Dr. Smith never 
resorts to this agent. He altogether prefers chloral 



146 CONVULSIONS. 

hydrate, thus not only avoiding the danger of para- 
lyzing the respiratory center, but also of being com- 
pelled to remain three or four hours with the patient. 
Concerning the hot bath, he often finds it an exceed- 
ingly useful adjunct. In cases, so frequently met 
with, where convulsions are threatened, with sudden 
twitching, starting, etc., and especially if the hand is 
affected or the thumb turned in, he has repeatedly 
found that by placing the child in a tepid bath of 
ioo°, a soothing effect is obtained and sleep often 
induced after its use. The hot bath, however, may 
in some instances, be too stimulating, but he finds 
no objection in applying it to the extremities, as in 
the majority of cases active or passive cerebral con- 
gestion is present, which may be thus relieved. 

In cases of convulsions, reflex in character and 
dependent upon intestinal irritation, Dr. A. JACOBI 
gives a purgative dose of calomel, following this in a 
few hours afterward by : 

]pL Chloral, hydrat gr. iv. 

Potass, bromidi . . gr. viii. 

Aquae 

Syrupi aa q.s. 

M. Sig. Dose, to a child of two years. 

This, he finds, together with attention to diet and 
proper hygiene, is usually sufficient. During the 
convulsive spasms he also cautions that the child 



CONVULSIONS. 147 

must not be touched, since such disturbance may- 
increase their severity, or give rise to others when 
the patient is recovering. 

In the nervous disturbances and excitements of 
children, Dr. A. A. SMITH uses the bromides very 
beneficially. He advises, however, that the adminis- 
tration of bromide to young children is often difficult, 
on account of the disagreeable taste attending its 
use. This he very effectually obviates by giving the 
drug in small and frequently repeated doses ; usually 
selecting the sodium salt for this purpose, as being 
less nauseating, and administering it as follows : 

9. Sodii bromidi . . . gr. xxx-lx. 
Aquae . . . § iv. 

M. Sig. A teaspoonful every ten or fifteen min- 
utes. 

When given in this manner, he finds that the 
remedy often renders most valuable service in the 
nervous affections arising from dentition and other 
causes, and in relieving the fever which, in children, 
usually attends any slight degree of excitement. 

Also, in those cases of highly nervous, fretful, and 
excitable children, "so frequently met with, where 
there is inability to sleep at night, the indication 
being to administer a sedative, he recommends the 
following, which has been used by him with much 
satisfaction : 



148 CONVULSIONS. 

Ijjfc. Tinct. chamomillae . . m. viii. 
Aquae 3 i. 

M. Sig. A teaspoonful every fifteen or twenty 
minutes. 

This, he advises, is also a tonic as well as sedative, 
and in these cases acts far better than chloral hydrate 
which is often liable to affect the digestion. 

In the convulsions of childhood, during an attack, 
whether due to organic disease or to functional 
disturbance, Dr. Smith directs that the convulsion 
be arrested at once and another prevented by the 
administration of anaesthetics, preferably cliloro- 
form. If dependent upon pain produced by other 
than causes such as the pricking of a pin, tight abdo- 
minal bandage which can be easily removed, or an 
overloaded stomach which should be emptied by an 
emetic, he considers opium the most valuable rem- 
edy, employing it in all children over four months 
old. Where the convulsion depends upon the pain 
of teething, he first controls this by opium, and then 
uses the gum lancet. Regarding lancing the gums, 
he believes that if they are swollen and hot, they 
should be lanced ; or, if it is time for the tooth to 
appear, he also resorts to scarification, as he finds 
that the irritation is often due to deepseated 
pressure which is not manifest upon the sur- 
face. In such cases, according to his experience, 



CONVULSIONS. 149 

lancing the gums is frequently followed by marked 
relief. 

The same principle is embodied in his treatment 
of convulsions due to worms, or other foreign bodies 
in the intestinal canal. Opium is first administered 
and then a cathartic given ; or sometimes he com- 
bines the opiate and cathartic with advantage. 
Where the source of irritation is in the rectum, or 
near it, after the influence of opium is sufficiently 
secured to control the convulsion, an enema is given. 
In convulsions due to malarial poison, having ar- 
rested the paroxysm by opium, he puts the child 
fully under the influence of quinine to prevent its 
recurrence. In this latter class of cases, he advises 
that the tolerance of opium is sometimes very 
great. 

Therefore, as in most instances, opium is indicated, 
he directs the mother to give the baby, if over four 
months old, paregoric, with explicit instructions re- 
garding the size of the dose, to be repeated every 
half hour until the convulsion ceases, or a physician 
arrives. Where the child is under four months of 
age, he prescribes the following with best effect : 
5. Potass, bromidi .... 

Chloral, hydrat. 

Sodii bicarb. aa gr. xvi. 

Aquae ferv. . . . . 3 ii. 



150 CONVULSIONS. 

Sacchari q.s. 

M. Sig. A teaspoonful every hour. 

Many times, however, in infants from six weeks to 
four months old, he gives double the quantity every 
hour, or every two hours, according to the frequency 
and the violence of the convulsions. 

Regarding the use of the hot bath, Dr. Smith 
finds that one or more spasms almost invariably 
occur while the child is in the bath, owing to the 
excitement, etc., in administering it ; hence, as it is 
necessary to the treatment to avoid all agitation, he 
objects to its employment. He moreover insists 
that the child be not restrained while in a convul- 
sion, but that it be placed in bed in a room which is 
kept perfectly quiet, partially darkened, and supplied 
with plenty of fresh air. The opening and shutting 
of doors are also to be avoided, and only one person 
permitted to remain in the room at a time. These 
minute particulars he considers essentially of great 
importance. He further advises that all over-active 
treatment is not only uncalled for, but may be posi- 
tively dangerous. 

In those instances where the prolonged use of 
opium is undesirable, he believes the bromides to be 
of marked value ; their sedative effect must, how- 
ever, be maintained. He finds their action very 
useful in averting threatened attacks ; also particu- 



CONVULSIONS. 151 

larly favorable in the cases of convulsions in young 
children, apparently due to the intense itching which 
especially follows scarlet fever and measles. Where, 
however, the symptoms are aggravated by the bro- 
mides, he uses chloral with good effect. In the convul- 
sions of hooping cough, he gives the bromides and 
chloral in combination. If associated with disease 
where there is a tendency to heart failure, or with 
the exhaustion of severe diarrhoea, he resorts to 
stimulants, preferably musly and camphor. In con- 
vulsions depending upon high temperature, he 
administers veratrum viride, as follows : 

]pfc. Tinct. verat. viridis . . gtt. ii. 

Sig. Dose, every hour or two, to a child of 
six to eighteen months. 

Or, he sometimes gives it in combination with 
opium, thus preventing its tendency to cause vomit- 
ing. Where this remedy fails, however, he orders a 
cold bath, as the most efficient means for this object. 
For the convulsions occurring at the onset of an 
acute pulmonary affection, he finds the administration 
of calomel in sedative doses of gr. v., to a child of one 
to three years, often very serviceable. This he also 
combines with the use of veratrum viride and the 
cold bath, if necessary. 

Regarding the subsequent treatment, Dr. Smith 
advises that the child be kept in the best possible 



152 CONVULSIONS. 

condition, at the same time directing his treatment 
to the removal of the causes, as well as of the pre- 
disposing causes ; e. g. y the rickety diathesis, syphilis, 
rheumatism, disturbance of digestion, nervous excite- 
ment, etc. 

In the spasms occurring in young girls at about 
the age of puberty, and evidently due to a diffused 
pelvic irritation, no dyspepsia or local disease being 
present, De. E. C. Seguin finds medicinal treatment 
somewhat uncertain. He sometimes derives benefit 
from giving the bromide of potassium in moderate 
doses, thus : 

5- Potass, bromidi . . gr. xx. 
Aquae q. s. 

M. Sig. Dose, every night. 

In addition to this he applies a blister to the back 
of the neck, with much benefit. In other cases, 
however, this treatment entirely fails of relief. 
Again, he uses ergot, giving it in view of the theo- 
retical cause of fullness of the ovarian plexuses, and 
has at times found it very serviceable. 

For local action in controlling infantile convul- 
sions, the following is very highly recommended by 
some, and has been found to almost invariably arrest 
the paroxysm : 

9- Olei succini rectif. 

Tinct. opii aa §ss. 



CHOREA. 153 

Olei olivae 

Spts. vini gall aa § ii. 

M. Ft. lotio. 

Sig. Rub along the spine. 
Before the application is made, it is directed that 
especial care should be taken to see that the skin is 
well washed with warm water and soap, in order to 
promote rapid absorption. 



CHOREA. 



Dr. J. Lewis Smith finds that under good hy- 
gienic conditions this disease usually terminates in a 
few months. This termination he endeavors to 
hasten by suitable treatment. If the child attends 
school, especially public school, the disease is apt to 
be aggravated by the severe discipline attached to 
these institutions, therefore he advises remaining at 
home for a season. For internal treatment, where 
no organic lesion is present to account for the chorea, 
and considering the case purely as a neurosis, he 
usually derives much benefit from placing the child 
on the use of arsenic, giving : 

9- Liq- potass, arsenit. . . . gtt. v. 



154 CHOREA. 

Aquae q.s. 

M. Sig. Dose, three times daily, to a child ,of 
eight to ten years. 

This is gradually increased to gtt. viii-x. three 
times daily. 

Or, in other cases, he gives Fowler's solution, 
m. ii. after each meal, together with the follow- 
ing: 

9- Ferri et potass, tart . . . . 3i. 
Tinct. cinch, co. . . . .5 lv - 

M. Dose : A teaspoonful three times daily. 

With these measures, he insists that the hygiene of 
the patient should be strictly attended to, the 
bowels kept open, plain nourishing food given, and 
pure air insured. By careful attention to these 
means improvement rapidly follows. 

In cases of chorea associated with organic heart 
disease, with anaemia, etc., for general treatment, 
where there is little or no fever, Dr. A. Jacobi admin- 
isters a course of iron. For this purpose he prefers 
the subcarbonate or the pyrophosphate, in doses 
amounting to gr. xx-xxv. daily. The tincture of the 
chloride and the muriated tincture are avoided, from 
being vascular irritants. For the chorea, he places 
most reliance upon arsenic, using either the sodium 
or potassium salts, as follows : 

5- Sol. Fowlerii .... gtt. iii. 



CHOREA. 155 

Aquae . . . . . q. s. 

M. Sig. Dose, three times daily, after meals. 

This amount he gradually increases to gtt. vi-viii. 
In all cases, he believes it to be of the greatest im- 
portance that these children should rest well at 
night ; hence in severe forms of the disease, when 
the muscular twitchings persist disturbing and inter- 
rupting the sleep, he endeavors to control this con- 
dition by the administration of chloral and the 
bromides, thus : 

9. Chloral, hydrat. . . . gr. xv. 
Potass, bromidi . . gr. xv-xxiv. 
Sig. Dose, at bedtime, to a child of eight to 
ten years. 

If necessary, to accomplish its object, he increases 
the chloral to gr. xx-xxv. 

Dr. W. A. Hammond finds the following often of 
excellent service : 

9- Zinci bromidi . . . . 3 i. 
Syrupi simp. . . . . 3 i. 

M. Sig. Ten drops, three times daily. 

In using this, he advises that the dose must be in- 
creased as rapidly as the stomach can bear it ; then, 
with the disappearance of the chronic symptoms, it 
is to be gradually lessened. He also prescribes the 
following in many instances, and considers it highly 
efficacious : 



156 CHOREA. 

1$. Strychniae sulph. gr. ii. 

Aquae § i. 

M. Sig. Five drops, three times daily, to a child 
of ten to fifteen years. 

Dr. E. C. SEGUIN recommends hyoscyapius with 
much satisfaction. Regarding the administration, 
he finds that it can be given in small doses, hypo- 
dermically, with ease, and distinct effects obtained 
from gr. t ^. The following formula is generally 
used by him : 

1$. Hyoscyamiae (Merck's crystallized) gr. i. 

Glycerinae 

Aquae destill aa m. c. 

Acidi carbol. pur. . . . gtt. i. 

M. Filtra. 

Sig. m. i. contains gr. 2 J . 

Of this he considers m. ii. as a moderate dose, and 
m. iv. a full dose. For administering by the mouth, 
he uses tablets containing gr. 5 \ very conveniently. 
He has also found the fluid extract of conium very 
beneficial ; giving it in large doses for the purpose 
of obtaining the paralyzing effects of the drug. 

As a rule, however, arsenic is most uniformly suc- 
cessful. In cases of post choreic paralysis he places 
great reliance on Fowler s solution in doses of gtt. v. 
at first, and gradually increasing. If the chorea is 
violent, chloral is also given. By this means, to- 



CHOREA. 157 

gether with extra feeding, rest, and rubbing, Dr. 
SEGUIN finds that these cases of even very grave 
paralysis will get well within two or three weeks. 
On the other hand, he cautions that if large doses of 
arsenic are given, the patient may linger for months. 
In his experience the cold shower, chalybeates and 
cold water do not act as quickly in chorea as the thor- 
ough arsenical treatment. 

In choreic children, Dr. W. H. THOMSON con- 
siders zinc and arsenic most serviceable ; of these he 
prefers the former, giving zinci sidpJiat. gr. i. tJirce 
times daily, and increasing till nausea is produced. 
From this treatment he has had marked improve- 
ment within a week. For the abnormal condition of 
the nervous system, with faulty nutrition, impaired 
memory, etc., he prescribes the following with 
benefit : 

9. Ferri lactat 

Quiniae sulph. ... aa gr. xx. 

Pulv. carbon gr. xl. 

M. Ft. pulv. No. x. 

Sig. One, three times daily. 

This he directs to be taken in cod liver oil. He 
further advises, that even though great improvement 
in the chorea takes place, yet the general treatment 
is to be continued for several months. 

Dr. E. G. Janeway, as a rule, derives most success 



158 EPILEPSY. 

from strychnia. Where there is also marked anaemia 
present, he places the child on the use of iron, in 
small doses, and continues it for some time. 

At the New York Hospital the following arsen- 
ious acid tonic is continually employed, and'is con- 
sidered to be a most efficient combination : 

Ipfc. Acid, arseniosi . . . gr. \. 

Ferri et quin. cit. . . gr. lxxx. 

Tinct. cinchon. co. . . . § ii. 

M. 



EPILEPSY, 



To ward off the immediate attack, Dr. W. A. 
HAMMOND directs that when the child feels an aura, 
gtt. iii-iv. of amy I nitrite be put upon a handker- 
chief and inhaled. This he has often found very 
efficacious, and has frequently succeeded not only in 
aborting a paroxysm, but in curing several cases of 
epilepsy by this method alone, and without the ad- 
ministration of any internal remedy. In many 
instances, however, he finds that even when aborted 
by amyl nitrite, the paroxysm is very apt to recur. 
In using it, he advises that the drug should be put 



EPILEPSY. 159 

to the mouth so that it may be inhaled thoroughly, 
and produce a sense of fullness in the head, a ting- 
ling of the surface of the body, and redness of the 
face. In certain cases, also, where the bromides 
have failed, he has derived much benefit from using 
nitrite of amyl internally, as follows : 

9- Amyli nitriti .... gtt. i. 
Sacchari q. s. 

M. Sig. Dose, three times daily, increased gradu- 
ally to gtt. iii-iv. 

He has also obtained excellent results from nitro- 
glycerine (or glonoin) in this malady, and finds its 
effects more permanent than amyl nitrite, although 
it takes a longer time to act. In the beginning of 
an epileptic attack, when used for the same purpose 
as amyl nitrite, he is able to effectually prevent the 
spasm of the arterioles by this means. Moreover, 
he has employed nitro-glycerine quite successfully 
for the permanent treatment of the disease. In the 
status epilepticus, and in cases of long standing, 
where the bromides have signally failed, he often 
finds this remedy very effective. Or, in some in- 
stances, he gives it in conjunction with the bromides. 
Regarding administration, the strength usually em- 
ployed by him is a one per cent, solution, of which 
he prescribes : 

5- Nitro-glycerin. . . . gtt. i. 



l6o EPILEPSY. 

Alcohol gtt. c. 

M. Sig. One drop three times daily, on a lump of 
sugar. « 

This amount, he advises, is borne very well by 
children. After a time he gradually increases the 
administration to gtt. v. as required. Under this 
treatment, he finds that some cases improve remark- 
ably, and not infrequently the attacks appear to be 
permanently stopped by this agent. Or, he fre- 
quently administers this drug in pill form, of which 
he prefers Metcalfs preparation. 

As a rule, however, and especially where the bro- 
mides have not previously been given, Dr. Ham- 
mond considers it best to begin with their adminis- 
tration in some form. Regarding the old remedies, 
such as the salts of zinc, etc., though sometimes 
beneficial, yet he finds them more so in conjunction 
with the bromides than when used alone. On the 
other hand, he advises that the bromides will almost 
invariably reduce the frequency of the paroxysms, 
and if the case is not an old one, they may effect a 
permanent cure. For administration he prefers the 
sodium salt, as it is much more pleasant to the taste, 
and if desired may be taken with the food. In his 
experience, the following is considered to be one of 
the best plans of treatment, and from which he has 
obtained uniformly good results ; he insists, how- 



EPILEPSY. l6l 

ever, that it must be rigidly carried out in all its 
details. In prescribing this treatment he usually 
begins with : 

p. Sodii bromidi . . . . § iv. 

Aquae Oi. 

M. Sig. A teaspoonful (gr.xv.) three times daily, 
to a child of eight to twelve years. 

He further directs that each dose is to taken 
largely diluted with water, as by this means the ef- 
fects of the drug are greatly increased. The efficacy 
of the above solution, he also advises, will be much 
enhanced by the addition of potassium iodide, 3 ss. 

Regarding the results of this method, he finds that, 
as a rule, it will take several days for the drug to 
produce its effects, as it acts very slowly. He then 
increases each dose by one-fourth every three months 
for a year, and continues it at that amount for another 
year ; after which he commences to reduce in the 
same manner, so that during the fourth vear the pa- 
tient takes gr.xv. of the bromide three times daily. 
In this respect, however, he cautions that if the quan- 
tity is not increased during the first year, the attacks 
will probably recur, thus adding to the difficulty of 
arresting them. Formerly, Dr. Hammond used to 
consider that two, or possibly three, years was long 
enough to continue giving the bromides ; but of late 
he believes that a relapse is thus encouraged, hence 
11 



162 EPILEPSY. 

he advises that it is safer to continue the treatment 
for four years. If, however, after a time, the bromides 
do not produce so good results as are desired, he 
stops their administration for a month or longer, un- 
til the system has become entirely free from the 
drug, and then begins the treatment anew; in the 
meantime giving cod liver oil and tonics, to quiet the 
nervous irritability, etc. Moreover, in all cases, he 
insists that unless a certain degree of bromism is 
produced, the disease cannot be cured. Any weak- 
ness short of inability to stand up, and an acne erup- 
tion on the face and chest, are, in his opinion, not 
contra-indications to a continuance of the treat- 
ment. 

To prevent the eruption of acne, he sometimes 
combines Fowler s solution with the bromide ; but, 
as a rule, when injurious effects are produced, he 
finds that the best plan is to diminish the dose. The 
combination of iron with bromide in epilepsy, he 
believes to be harmful. As to quinine, in his expe- 
rience the use of this drug in combination lessens 
the effect of the bromides upon the patient. 

In certain cases he finds that indolent ulcers are 
caused by the long use of the bromides ; these he 
usually easily cures by galvanism. Or, in a great 
many instances, pure bromine is employed by him 
instead of the salts, by which means the acne and the 



EPILEPSY. 163 

ulcerative manifestations of the bromide are, he be- 
lieves, avoided. His formula for this administration 
is: 

5. Brominii . . . . . 3 i- 

Aquae ...... J viii. 

M. Sig. A teaspoonful, well diluted with water. 

Another useful measure which Dr. Hammond re- 
sorts to very satisfactorily, in the treatment of 
epilepsy, is counter-irritation, applied to the back of 
the neck by means of a platinum disc, or other in- 
strument, heated to a white heat. In doing this, he 
advises that it is necessary only just to touch the 
skin, and then remove the cautery immediately ; 
the pain thus produced is so slight that the patient 
scarcely feels it. By this procedure, he has found 
the number of paroxysms to be reduced afte,r a 
single application. 

Dr. J. Lewis Smith urges the great importance 
of making a correct diagnosis early. If this is done, 
he usually controls its manifestations by the free use 
of the bromides, giving the following : 

5. Potass, bromid. . . . 5 ss. 

Aquae pur. . ... § v. 

M. Sig. A teaspoonful three times daily, in cold 
water. 

This amount is gradually increased as indicated. 

Dr. E. C. SEGUIN believes that attacks of the 



164 EPILEPSY. 

petit mal, or epileptic vertigo, though seemingly an 
insignificant symptom, is nevertheless far more se- 
rious than the grand mal, or fits, and does not al- 
ways receive the attention which its existence de- 
mands. He therefore considers that the importance 
of its early recognition cannot be magnified, and its 
existence should be met with prompt and careful 
treatment, at the earliest possible moment. The 
bromides are prescribed by him, together with atten. 
tion to the digestive apparatus, etc. ; although he 
finds that these cases, and especially the flash-like 
form, are exceedingly rebellious to treatment, and 
many children will continue to have several turns a 
day, despite the administration of as much bromide 
as their systems will bear. In several instances he 
has found it necessary to produce severe bromism, in 
order to barely control these minor forms of epilepsy ; 
and the least reduction of the medicine to a safer 
dose, has been followed by a return of the symptoms. 
In all forms of the disease, however, both in grand 
and in petit mal, he resorts to early treatment, if 
possible after the first or second attack, as by this 
means he is often able to eliminate the epileptic 
habit, and thus greatly increase the chances of cure. 

Regarding the convulsions, in children under three 
years of age, he advises, the first convulsions may prob- 
ably be eclamptic, but the causes of the attack should 



EPILEPSY. 165 

receive the most careful judgment. In these cases, that 
is to say, which do not present an evident eclamptic 
condition, he finds it well to give a moderate amount 
of potassium bromide with regularity, for several 
months after a convulsion. After the third year he 
believes the attacks to be, as a rule, epileptic, not 
forgetting the possibility of uraemia and syphilis. In 
such children, he at once institutes the bromide 
treatment, and continues it for many months. This 
plan, he advises, does not interfere with the treat- 
ment by appropriate remedies and by hygiene, of 
gastric or intestinal indigestion, of worms, or of other 
abnormal conditions. Moreover, in his experience, 
even the most severe fits can nearly always be con- 
trolled by a proper dosing of the bromides, and may 
also be suspended for a period of months and 
years. 

In giving the bromides, Dr. SEGUIN always en- 
deavors to ascertain the minimum dose which will 
control the seizure ; this amount is then increased as 
demanded. For administration, to commence with 
he generally prescribes : 

5. Potassii bromidi . . . § i. 

Aquae § vii. 

M. Sig. 3 iii-vi. daily. 

He also directs that each dose be diluted with 
vicky water y as in this way the taste is somewhat dis- 



l66 EPILEPSY. 

guised ; or, when this cannot be obtained, he finds 
that a pinch of soda in the water answers very well. 
Where there is much depression from the use of the 
bromides, he gives strychnia with considerable effi- 
cacy. In some cases he has also found iron to act 
very beneficially. When indicated, he combines 
chloral with the bromide, and often with remarkable 
effect; thus: 

9. Potassii bromidi . . . § i. 

Chloral, hydrat. . . . 3 ss. 

Aquae ..... 3 vii. 

M. Sig. 3 iv-vi. daily, in water. 

Again, in numerous instances he prefers to give 
the following : 

9- Ammon. bromidi . . . 3 ss. 

Potassii bromidi . . . § i. 

Aquae ..... 3 vii. 

M. Sig. 3 iii-iv. daily, increasing the amount as 
required. 

Furthermore, besides the use of the bromides, he 
finds that a variety of treatment is frequently re- 
quired, according to the pathological condition of 
each individual case. 



INFANTILE PARALYSIS. 167 



INFANTILE PARALYSIS. 



In those cases of paralysis which come on without 
any apparent premonitory symptoms, Dr. A. JACOBI 
relies a great deal upon the galvanic and faradic 
current, and upon strychnia both subcutaneously and 
internally, preferably the former, from which, also, 
he obtains better results by applying the injections 
directly over the affected part. For the same reason, 
in paralysis of the sphincter ani due to muscular re- 
laxation, he uses the alcoholic extract of nux vomica, 
as an ointment, with the most beneficial effect. Of 
this, the following strength is usually employed by 
him: 

J£. Ext. nucis vomicae . . gr. xii. 

Unguent 3 iii-iv. 

M. 

In so-called dental, or spinal, paralysis, to subdue 
the local inflammation, he advises the application of 
ice to the surface for hours or even days ; not for- 
getting, however, that infants and young children 
bear the protracted application of cold badly. For 
this reason, he usually keeps the ice in contact with 
the surface for an hour or two, and then, after re 
moving it for the same period of time, repeats the 



1 68 INFANTILE PARALYSIS. 

application ; continuing in this manner as long as 
necessary. If constipation is present he relieves it 
by giving calomel in doses of gr. v-x. according to 
age ; or sometimes a saline is used. In these cases 
he always uses ergot in large doses ; as a rule, 
giving : 

5. Ext. ergot, fl. . . . 3 i. 

Sig. This amount in twenty-four hours, to a 
child of one year. 

This administration he continues for three or even 
six weeks. Or, at times, larger doses are prescribed 
by him ; in some instances as much as 3 ii. In other 
instances, he prefers to use ergotin by hypodermic in- 
jection. Where the heart is feeble and requires 
stimulating, digitalis is employed. After the fever 
and pain and ail active symptoms have disappeared, 
he supplements the ergot by the addition of iodide 
of potassium to the amount of 32. in twenty-four 
hours. As regards inunction, he considers the oint- 
ment of potassium iodide of little or no service. In 
his experience glycerine and potassium iodide act 
better, and he has often observed, after such an ap- 
plication, the urine impregnated with iodine within 
twenty-four hours. He has also found iodoform 
ointment exceedingly beneficial, or better, the fol- 
lowing : 

I£. Iodoform! . . . pars i. 



INFANTILE PARALYSIS. 1 69 

Collodion . . . part, xii-xx. 

M. Sig. To be applied three or four times daily. 

Besides, this being non-irritating, he finds that it 
can be continued for weeks with no ill effects. 

Regarding pseudo-hypertrophic paralysis, Dr. 
JACOBI has succeeded in curing a case by means of 
the hydrarg. corros. chlor. in doses amounting to gr. 
4*0 -/o m twenty-four hours, and continued for a 
period of eighteen months. Under this treatment, 
nutrition was not impaired in the least from the ef- 
fects of the drug, but on the contrary the child ate 
and slept well, became rosy and healthful, and 
the atrophy and hypertrophy finally both gave 
way. 

Dr. F. Delafield's indications for treatment are 
to support the strength and nutrition, and render 
the patient as comfortable as possible. Any derange- 
ment of digestion is carefully attended to, and the 
bowels kept freely open. While the disease is pro- 
gressing, he considers it a good plan to apply dry 
cups along the spine ; but after this stage has passed, 
and the disease has reached a systematic develop-, 
ment, he obtains marked benefit from using the 
faradic current, and in thoroughly rubbing the 
muscles at stated periods. 

DR. W. A. HAMMOND considers ergot to be of ex- 
cellent service, in cases of infantile spinal paralysis 



IJO INFANTILE PARALYSIS. 

before the stage of atrophy has set in. He generally 
prescribes : 

I£. Ext. ergotae fl. . . . J i. 

Sig. Ten drops three times daily, to a child 
of six months. 

In conjunction with this, local measures are also 
employed. After the period of atrophy is reached, 
he then administers the following : 

1$. Strychniae sulph. . . . gr. i. 
Ferri pyrophosph. . . . 3 ss. 

Acidi phosphorici dil. . . J ss. 

Syrupi zingiber. . ■ . . 5 iiiss. 

M. Sig. m. xx. three times daily, to a child of 
two years. 

From this he has often derived marvelous effect. 

In infantile hemiplegic paralysis, Dr. E. C. Seguin 
varies his treatment according to the pathological 
diagnosis, e. g. The treatment of a case depending 
upon convulsions from injury, will differ materially 
from one in whichttubercular meningitis is suspected ; 
or one in which some gastric irritation is thought to 
exist. In the first stage of hemiplegia in children, 
he finds that it is best to avoid doing too much. 
The only exception to this, he advises, is in cases 
where, at an older period than mere babyhood, con- 
vulsions occur followed by hemiplegia of a rather 
slowly developed kind, and continued convulsions in 



INFANTILE PARALYSIS. l/l 

which the teeth are bad, etc. In these cases his 
general rule not to do too much is reserved. Mer- 
cury, potassium iodide, and cod liver oil will, he 
finds, do a wonderful amount of good. 

Regarding treatment of the sequelae, nothing can 
be done for the pathological degenerative changes in 
the brain. Various clinical sequelae are however 
met according to the indication. The athetoid and 
choreic conditions he endeavors to correct by gym- 
nastics, massage, and electricity. Epilepsy, which is 
often present, is treated by the bromide of potassium ; 
but he advises that, in these cases, the drug is not 
required in large doses as in common epilepsy. Or, 
in many children who exhibit the remains of 
hemiplegia and epilepsy at the same time, Dr. 
Seguin has obtained excellent results from the com- 
bination of the iodide and bromide of potassium. In 
such cases, he generally gives : 

]J. Potass, iodidi . . . . gr. v. 

Potass, bromidi gr. x. 

Aquae ..... q.s. 

M. Sig. Dose, twice daily, to a child of four or 
five years. 

At the same time, he directs that the general con- 
dition, the hygiene, etc., should receive the most 
careful attention. Where imbecility exists, this is 
to be corrected by judicious training ; and in the 



172 INFANTILE PARALYSIS. 

case of the poor, he advises that the parents be in- 
structed to send their children to the schools for 
idiots. For whatever deformity that may be present 
he aims to remedy this by proper treatment, partly 
by massage, by electrical treatment, exercise, and 
also by orthopaedic apparatus. In regard to electrical 
treatment, he advises that this must be applied to 
the weakest muscles. If the whole arm is faradized 
the child is made worse. Where, however, the 
faradization is limited to the extensors and interossei, 
he often obtains a marked change in the child's hand 
and arm in the course of a few weeks. Moreover, 
the current should be strictly localized ; the elec- 
trodes are to be placed close together, so as to pro- 
duce contraction in all the weakest muscles, the 
flexors requiring no treatment. Massage and passive 
movements are also considered very important. In 
some cases, the maintenance of the normal attitude, 
or even over-extension in the clenched instances by 
a little apparatus, will, he finds, do a great deal of 
good. The child is also forced to use the hands and 
legs, at intervals ; the well hand being tied up for a 
few hours a day, according to the temperament of 
the child. Finally, what in the education of idiots 
is called pJiysiological training of muscles, is con- 
sidered of the greatest importance, and should be 
attempted in all cases ; e. g., training the hand for 



ACUTE MENINGITIS. 1 73 

delicate movements, by a graduated series of little 
muscular exercises. 

Therefore, under this plan of treatment, carefully 
and persistently carried out, if the circumstances are 
favorable, Dr. Seguin finds that a great deal can be 
done for these children. 

At Bellevue Hospital the following solution of 
ergot is employed for hypodermic use : 

9- Ext. ergotae e fl. (Squibb) . gr. lx. 
Aquae q.s. ad ... m.ccc. 

M. Sig. m.i. contains gr. i. 

A similar preparation is also used at the NEW 
York Hospital. 

At Charity Hospital the following is adminis- 
tered : 

9- Ergotini . . . ' . gr. xxxvi. 
Glycerinae 
Aquae . . . . aa m. cviii. 

M. 



ACUTE MENINGITIS. 



To subdue the local inflammation, Dr. F. Dela- 
FIELD advises that the employment of blood-letting 
and cold will depend upon the age and constitution of 



174 ACUTE MENINGITIS. 

the patient, and the period at which the case is seen. 
To a strong, full-blooded child in the early stage of 
the disease, he administers a brisk purge, and then 
proceeds to draw blood by wet cups or leeches^ 
applied over the temples and back of the neck. This 
procedure, he advises, must be resorted to at the 
commencement and during the first forty-eight hours 
of the disease, when he finds it of excellent service ; 
after that period has passed, however, no benefit is 
derived from its use. He also employs cold in the 
shape of ice-bags, applied by cutting the hair and 
covering as much of the surface of the cranium as 
possible ; and by placing an ice-bag beneath the 
neck and adjacent part of the head. This applica- 
tion of cold he finds most serviceable during the 
first two or three days,' but continues its use with 
much benefit throughout the first week. Opium is 
also administered in some form, to quiet the restless- 
ness and delirium. 

If the case is not seen until five or six days have 
elapsed, he considers opium, cold, bleeding, and all 
depleting measures contraindicated, and should be 
avoided. At this stage, he administers iodide of 
potassium in moderate doses, and supports the 
strength of the patient with quinine, iron, etc. 

When the disease occurs as a complication, or in 
asthenic children, he objects to blood-letting, but 



ACUTE MENINGITIS. 



/o 



applies cold to the head and administers opium to 
relieve the pain ; or. should opium be contraindicated, 
he gives potassium bromide or chloral, or both. A 
purge is also given unless the bowels are already 
relaxed from the concomitant disease. 

In cases of basilar meningitis. Dr. E. C. SEGUIN 
derives excellent results from iodide of potassium, 
its administration often causing amelioration of the 
symptoms, with rapid general improvement and. in 
many instances, final recovery. Moreover, in these 
cases he believes syphilis ma}- often be entirely ex- 
cluded. In conjunction with this, he also resorts to 
counter-irritation by means of blisters, applied to the 
back of the neck. Regarding the use of potassium 
iodide, to accomplish its object, he finds that large 
doses may be required and can be given with appar- 
ent impunity. Even in young children of eight to 
ten years, he has. in some cases, found it necessary to 
give the following : 

R. Potassii iodidi . . gr. xxx-cl. 

Aquae ..... q.s. 

M. Sisr. Dose, three times dailv. 

Dr. \V. A. Hammond has also obtained like bene- 
fit from this remedy. In many instances, however, 
he advises that enormous doses, may be necessary 
before success follows. Therefore, to facilitate this 
administration, when prescribing the drug he directs 



176 ACUTE HYDROCEPHALUS. 

that a great deal of water be taken with each dose, 
sometimes a pint, as in this way he finds that these 
large doses may be given without any inconvenience 
and iodism prevented. 



ACUTE HYDROCEPHALUS. 

(tubercular meningitis.) 



Dr. F. Delafield directs his treatment chiefly to 
the symptoms. If the urine is scanty or suppressed, 
he orders a hot bath for the space of five minutes, 
after which the child is immediately wrapped in a 
blanket, without waiting to dry the body, and thus 
kept in a sweat for one, two, or more hours. 
Diuretics he finds of little use, although he sometimes 
gives the iodide or acetate of potassium. For the 
irritability and restlessness, he administers the 
bromides with chloral ; thus : 

9- Potassii bromidi . . . gr. i-v. 
Chloral, hydrat. . . gr. i-iii. 
Aquae q. s. 

M. Sig. Dose, every two or three hours. 

In addition to this, to act on the inflammation, he 



SPURIOUS HYDROCEPHALUS. IJJ 

uses potassium iodide in doses of gr. it— v. according to 
the severity of the case. Locally, counter-irritation 
is resorted to by means of blisters applied to the 
neck. He also applies cold to the scalp, ab- 
stracts blood from the temples, and produces free 
catharsis. For internal medication Dr. DELAFIELD 
further administers ext. ergotce fl. in large doses. 
Where convulsions are very marked, chloroform may 
be resorted to chiefly for the mother's sake. 

In the earlier stages, before effusion has taken 
place, the two remedies upon which Dr. J. LEWIS 
SMITH. places most reliance are ergot and potassium 
iodide. If nervous symptoms are developed he 
gives bromide of potassium in addition. He usually 
prescribes : 

9- Potassii iodidi gr. xvi. 

Aquae . . . . . § i. 

M. Sig. A teaspoonful every hour, to a child of 
one year. 

With this he gives fluid extract of ergot (Squibb* s) 
gtt. vi-viii. every three hours. As regards post aural 
vesication, although it does no harm, yet he believes 
that very little good results from resorting to it. 



SPURIOUS HYDROCEPHALUS. 

See Cholera Infantum. 



178 CHRONIC HYDROCEPHALUS. 



CHRONIC HYDROCEPHALUS. 



In congenital cases, Dr. F. Delafield finds that 
very little can be done in the way of treatment, 
beyond supporting the nutrition of the child by 
suitable means, and correcting the disordered diges- 
tion. By careful attention to these measures, in the 
milder forms of the disease, the child may improve. 

In cases of acquired hydrocephalus, that is to say, 
where the lesion occurs secondarily, he finds that 
treatment is altogether useless. 

Regarding tapping, Dr. E. C. SEGUIN does not 
apprehend any special danger from the operation ; 
this, he believes, will lie more in the hemorrhage 
than in the reaction, in these cases. He advises, 
however, that if the hydrocephalus is due, as is some- 
times the case, to a plugging of the aqueduct of 
Sylvius, tapping can only act as a mechanical relief. 
Also, if the disease affects the ventricular lining, he 
would hardly expect more than momentary relief 
from tapping. 



CEREBRO-SPINAL MENINGITIS. 1 79 



CEREBRO-SPINAL MENINGITIS. 

Th% treatment adopted by Dr. F. DELAFIELD is 
very largely symptomatic. For the local lesion, he 
advises that bleeding should rarely be practiced in 
children, although in robust patients he sometimes 
abstracts blood from the temples, the neck, or along 
the upper part of the spine. This measure, he fur- 
ther cautions, is of service only during the first three 
or four days, and if the case is not seen until then, 
bleeding is contraindicated. He also applies cold to 
the head and back of the neck, by means of ice-bags, 
and in severe cases this is kept up continually for 
the first week. These measures are, he finds, the 
most efficient means of treatment, but insists that 
they are available only during the first stage of the 
disease. 

For the restlessness and delirium, when excessive, 
he administers the bromides, or chloral, or hyoscy- 
amus. He frequently gives potassium bromide gr. 
iii-x. every three hours, but considers it more efficient 
when combined with one of the other drugs. Also, 
where the child cannot take the bromide alone, he 
usually prescribes the following : 

9. Potassii bromidi . . . gr. iii-x. 



180 CEREBRO-SPINAL MENINGITIS. 

Tinct. hyoscyami . . . 'm.xv-xl. 

M. Sig. Dose, every three hours. 

At times, he finds it necessary to resort to opium. 
Regarding quinine, he advises that it should be em- 
ployed only as a matter of routine, as he believes 
that it has very little effect on the temperature. 
Where the fever runs high he prefers cold as an anti- 
pyretic ; either in the form of affusions, or the cold 
or tepid bath, or occasional sponging which serves to 
render the patient more comfortable. Stimulants 
are also used by him in the later stages of bad cases, 
but, as a rule, he finds no indication for them during 
the course of the disease. For the vomiting, when 
it occurs in the early stage he disregards it alto- 
gether, unless very excessive, or continued beyond 
twenty-four or forty-eight hours ; in such cases, he 
directs that small and frequent allowances of iced 
milk and lime water be administered, and the patient 
given small pieces of cracked ice to swallow. Should 
the vomiting still persist, he finds the following used 
with caution, very successful in checking it: 

]J. Acid, hydrocyan.dil. m. i-ii. 

Sodii bicarbon. . . . gr. iii-v. 

M. Sig. Dose, every three or four hours, to a 
child of eight to twelve years. 

The constipation he relieves by an occasional mild 
laxative. 



CEREBRO-SPINAL MENINGITIS. l8l 

For the conjunctivitis, Dr. Delafield resorts to 
the continued application of hot or cold cloths, ac- 
cording as one or the other affords most relief to the 
patient, but, in either case, he insists that they be 
made hot or cold, not warm. When keratitis is 
present he uses hot cloths, together with the follow- 
ing: 

Ijfc. Atropiae sulphat. . . . gr. ii-iii. 
Aquae destil. . . . . § i. 

M. Sig. To be dropped into the eye, three times 
daily. 

The inflammation of the choroid, he advises, 
cannot be effectively treated ; all that can be done 
is to relieve the pain by a sufficient amount of 
opium. 

For the general nutrition of the patient, this he 
maintains by a diet of milk, or milk and beef-tea, 
frequently administered. 

Dr. J. Lewis Smith places the child freely under 
the influence of potassium bromide, with ergot in the 
beginning, and the local use of cold in the shape of 
ice-bags, applied to the head and neck. He also 
resorts to the moderate and cautious employment of 
opiates, for the relief of pain and to procure rest. 
During the first two or three weeks he considers 
medicinal treatment of most importance. After this 
period has passed, however, his chief reliance is upon 



1 82 CEREBRO-SPINAL MENINGITIS. 

good nursing, and the use of a nutritious but non- 
stimulating diet. 

In sudden attacks of severe cases, where the gen- 
eral symptoms are marked, opisthotonus prominent, 
and with jactitation, convulsions, etc., Dr. F. A. 
BURRALL directs that a mustard bath be given and 
sinapisms applied to the neck, together with sol. 
morph. sulph. (Magendie) m. iii-iv. hypodermically, 
to a child of eight or ten years. This usually 
shortens the duration of the paroxysms and dimin- 
ishes their intensity. Should, however, this condi- 
tion persist or exaggerate in degree, with increasing 
stupor, he administers the hot mustard bath three 
times daily, and applies continuous strong sinapisms 
to the nape of the neck, with the effect usually of 
rendering the patient more quiet. These, together 
with the bath, are also continued as required. For 
the constipation, hydrarg. chlor. mit. gr. \ is given 
every hour, until free fecal movement is established. 

He also gives the following internally, and gener- 
ally with beneficial effect : 

IJ. Potassii iodidi gr. v. 

Potassii bromidi gr. x. 

Aquae q. s. 

M. Sig. Dose, every two hours. 

In some instances, however, he has used up to 
3 i. of the bromide, with little or no relief whatever. 



CEREBRO-SPINAL MENINGITIS. 1 83 

To control the restlessness at night and secure 
sleep, he gives tinct. opii deodor. 3 ss. in divided 
doses. This, together with the bromide, is also freely- 
administered during the day, when demanded. 

For nourishment, a diet of milk is ordered, com- 
bined with stimulants, usually brandy, in the propor- 
tion of 3 ss. to ^ iv. of milk ; this is given ad lib. and 
the brandy increased as required. 

Dr. W. H. Draper advises that the child be con- 
fined to bed, and kept perfectly quiet and at rest. 
As rest is considered to be thoroughly essential to 
the treatment, where there is much agitation ex- 
hibited he keeps the patient under the influence of 
opium, in sufficient quantity for this purpose. The 
rational measures employed by him consist in the 
internal administration of ergot and iodide of potas- 
sium. The ergot is given in large doses, in order to 
control the amount of blood carried to the spine ; 
and, as a rule, he finds that the drug acts favorably 
in this disease, although in some instances ergot 
affords absolutely no benefit at all. Where the patient 
is unable to retain medicine by the mouth, he uses 
the hypodermic method. In conjunction with this 
potassium iodide is also administered, either by the 
stomach or rectum, with the object not only of con- 
trolling the inflammation, but also of removing the 
inflammatory products. In addition, the patient is 



1 84 SPINA BIFIDA. 

usually allowed to take all the food wanted, causing 
no serious consequence. , 

These means -of treatment are, in his experience, 
not always reliable, and in some instances are en- 
tirely negative, e. g. In certain cases he finds salicylic 
acid in doses of gr. viii-x. every two hours, very ser- 
viceable, on the plan of its utility in infectious 
diseases. 



SPINA BIFIDA. 



In young children where the general health is ap- 
parently good, while the tumor is present and small 
in circumference, Dr. L. A. Sayre believes that, as 
a rule, it is best to wait for nature to form a bony 
covering over the exposed parts, just as the fonta- 
nelles are closed in. In the meantime, should the 
tumor have reached any considerable proportions, 
he protects it artificially, and endeavors to assist os- 
sification by the administration of internal remedies. 
The former he accomplishes by means of a plaster 
jacket carefully applied, and perfectly encasing the 
tumor ; thus, also, guarding against any injury to the 
part. Or, a piece of steel or copper plate of appro- 



SPINA BIFIDA. 185 

priate shape, he finds, sometimes answers equally as 
well, provided it can be kept in exact position ; on 
account of this usual difficulty, however, he greatly 
prefers the plaster dressing. For internal treatment, 
he places the child on a course of lime, using the 
phosphate with a view of increasing the earthy phos- 
phates in the system, and thus facilitating the 
further ossification of the spinal column. 

After repeating the plaster application as occasion 
requires, Dr. Sayre sometimes resorts to aspiration 
with much satisfaction, and in many instances no in- 
convenience whatever is experienced during the op- 
eration, or subsequently, beyond some nausea and 
vertigo on rising in the morning. Where the tumor 
refills rapidly, he often finds it necessary to put in a 
permanent drain. 

In infantile cases, Dr. A. Jacobi sometimes places 
the child on the systematic administration of ergot 
and iodide of potassium, given in small doses, and 
continued for a considerable period of time. 

Dr. H. B. Saxds advises that although such 
measures are not entirely hopeless, yet operations 
for removal of the tumor are, as a rule, attended by 
disastrous results. When he resorts to any form of 
treatment, it is more frequently by the injection of 
iodine, or some such fluid. 

[LISTER considers the following plan of treatment 



1 86 TYPHOID FEVER. 

the best at present known, and believes that incision 
or antiseptic drainage, even with only one or two 
horsehairs, do not offer a prospect of success. Where 
the tumor is steadily increasing in size, he draws off 
about an ounce of the fluid, and injects 3 *". of Morton' s 
iodo-glycerine solution. If no effect is produced, in 
about a week's time he repeats the operation, inject- 
ing 3 iss. of the solution. As a rule, no bad symp- 
toms follow, and, in favorable cases, under this 
treatment he finds that the tumor gradually becomes 
solid, and shrinks until it remains as a puckered fold 
of skin only. Of late, however, in many instances 
he recommends that no fluid whatever be drawn, 
from danger of fatal consequences from loss of the 
cerebro-spinal fluid.] 



TYPHOID FEVER. 



Dr. W. H. Draper directs his treatment, (a) to 
maintaining the strength of the patient, and (b) to 
guarding against the accidents which are liable to 
occur. 

Rest is considered absolutely essential. Any source 
of irritation is avoided, and all disturbing thoughts 



TYPHOID FEVER. 1 87 

and muscular movements carefully prevented. This, 
he advises, should always be insisted upon, as pa- 
tients often exhaust themselves greatly during the 
early stage of the disease, by being up and about as 
usual, and thereby lessen their chances for a good 
recovery. 

For the diet, these patients, he directs, should not 
be over-fed. It should also be remembered, in feed- 
ing, for what object the food is given. When con- 
fined to bed, very little mental or mechanical work 
is done ; hence, the most important use for food is 
to repair the loss of heat resulting from fever. 

If there is high fever with active delirium, more 
food is required than in low fever. Milk is believed 
by him to be the best kind of food for the great ma- 
jority of cases. Sometimes, however, the patient 
cannot take a purely milk diet for any length of 
time ; in such instances, concentrated broths are 
given. These measures, judiciously employed, are, 
in many cases, all that he finds necessary. 

In the severer forms of the disease, to control the 
high temperature is, he advises, the most important 
feature in the treatment, and must be accomplished 
by every possible means. If this is not done, the 
patient dies from simple exhaustion. For an anti- 
pyretic, cold is, in his experience, perhaps the most 
reliable , used in the form of the bath, pack, etc. 



1 88 TYPHOID FEVER. 

These, he finds, have the greatest power, and are 
therefore useful for the greatest emergencies. While, 
however, this is employed with benefit in the early 
part of the disease, yet in the later stages he con- 
siders it dangerous to the visceral lesions. The bath, 
he directs, should be kept by the side of the bed, to 
avoid any unnecessary moving of the patient. Its use 
is resorted to, and the process repeated as often as 
necessary, indicated by the fever ; and in this way 
the temperature is continually kept near the normal 
standard. Where the bath is not practicable, he em- 
ploys frequent sponging very effectually ; either with 
warm or cool water, or with water and alcohol. This 
method is also less irritating to children, and is often 
quite successful in keeping the fever under control. 
This, however, he further assists by the administra- 
tion of diuretics and diaphoretics, allowing the pa- 
tient to drink freely of cold water, thereby cooling 
the blood, and favoring the excretion of matters 
which result from high temperature. Cold water 
enemata are also administered, too much covering 
avoided, and an abundance of cool and fresh air se- 
cured. This latter he finds exceedingly beneficial ; 
indeed, in his experience, cases treated in the open 
air show a much larger proportion of recoveries. 

Regarding the action of quinine, Dr. DRAPER 
sometimes uses it in large doses, as an anti-pyretic, 



TYPHOID FEVER. 1 89 

and with good effect ; but its results have not proven 
uniformly successful. When of service, he frequently 
finds that it owes its power to an effect on the essen- 
tial cause of the fever. Where, however, in this dis- 
ease, the temperature makes rapid and marked ex- 
cursions, he often gives quinine with great benefit. 
But to attain this, he insists that the drug must be 
administered in large doses ; small dosing does not 
appear to have the slightest* control in typhoid fever. 
For hypodermic use, the following is employed : 

9. Quiniae sulph. . . . gr.clx. 

Ac. hydrobrom. (Squibb) . 3 i. 

Spts. frumenti ad . § i. 

M. Ft. sol. 

Alcohol, he advises, acts as an antipyretic by fur- 
nishing a food which is easily appropriated, and thus 
supplies the force which the patient loses in heat, 
and saves loss and exhaustion from combustion of 
the tissues. The amount required varies in different 
cases ; it is given until the desired effect is obtained. 
In some children, 

Vini xerici .... § ii-iii. 

daily, is found to be sufficient ; in others, brandy in 
larger amount is necessary. By its stimulating effect 
it also quells the delirium and controls the locomotor 
disturbances. The heart's action becomes more 
steady and firm, and the first sound, which may have 



190 TYPHOID FEVER. 

been feeble or absent, grows distinct. In all cases, 
however, he directs that its administration should be 
cautiously proceeded with, and considers it of the 
greatest importance to bear in mind the indications 
for its use, viz : Alcohol is demanded when the pa- 
tient exhibits symptoms of marked nervous prostra- 
tion, with subsultus, delirium at night, jactitation, 
with a position in bed indicating great physical de- 
bility, and with a dry tongue ; all coming on with 
the increase of temperature. Under such circum- 
stances, as a rule, it controls the delirium and the lo- 
comotor derangements, the patient sleeps quietly, 
the tongue becomes moist, and the whole aspect of 
the case is changed for the better. If, however, it 
increases the frequency of the pulse, if the delirium 
becomes more active, the tongue more dry, the skin 
hot and parched ; if the motor spasms, tremulous- 
ness, subsultus, etc., are aggravated by alcohol, it is 
doing harm. 

The following case, occurring in Dr. Draper's ser- 
vice at the New York Hospital, will serve very effec- 
tually to illustrate the power of alcohol as an anti- 
pyretic : 

Boy, 13 years. Admitted Nov. 30. Four nights 
previous the patient was taken with severe pain in 
the abdomen, nausea, and vomiting, followed by high 
fever, with thirst, anorexia, prostration, etc.. Pulse, 



TYPHOID FEVER. I9I 

88 ; respiration, 24 ; temperature, 103 . Patient de- 
lirious. 

Dec I.— P. 118 ; R. 28 ; T. 105 . Spts. vini gall. 
§ viii. were administered during the day. 

2nd. — T. 103 . Patient delirious. Spts. vini gall. 

I xii. 

$d. — T. 102 . Brandy diminished. In the even- 
ing: T. 106. Brandy readministered as before. 

^th. — T. 100.4 . 11 A.M., temperature nearly nor- 
mal. Fever aborted ; no diagnosis made. 

For sustaining the heart power, besides the use of 
stimulants, digitalis is administered as indicated. 

In the management of the accidents of typhoid 
fever, the most careful judgment is insisted upon. 

Regarding leeches, blisters, etc., in his experience 
no benefit is derived from their application. Where 
perforation of a blood-vessel takes place, he enjoins 
absolute repose, and aims to control the diarrhoea as 
well as the patient's desire to defecate. To accom- 
plish this, opium is given internally, and styptics ad- 
ministered per anum. 

As to the value of phenic acid in typhoid fever, so 
strongly advocated by Dr. Declat, this plan of treat- 
ment has been employed by him at the above hos- 
pital, but, from the results obtained, he does not con- 
sider it deserving of much credit. 

During convalescence, Dr. Draper advises that 



I92 TYPHOID FEVER. 

the greatest care be exercised, from danger of re- 
lapse, perforation, and its serious consequence. There- 
fore rest and the most careful attention to the diet, 
are always insisted upon. 

Dr. Beverly ROBINSON calls attention to the 
great importance of the occurrence of sudden car- 
diac failure, in this disease. He believes, from very 
recent practical investigation, that at times, indeed 
quite frequently, there is a sudden and considerable 
dilatation of the cavities of the heart, more particu- 
larly of the right heart. In such a condition coagula 
may be formed, or, if free and strong stimulation be 
at once resorted to, the period of danger . may be 
tided over, and only partial failure, with dangerous 
but not fatal symptoms, occur. To guard against 
this peril, he advises that all unnecessary fatigue 
should be absolutely avoided, during the course of 
even mild cases of typhoid fever. The patient should 
not be allowed to rise unassisted in bed, or to sit up 
but a few minutes on any occasion, and under no cir- 
cumstances until convalescence is fully established. 
Self-feeding, or any act which calls for the expendi- 
ture of physical energy, and which can be prevented 
by careful nursing, should never be permitted. He 
also resorts to the administration of heart tonics in 
exceedingly moderate doses, from a comparatively 
early stage of the disease, more especially if the 



TYPHOID FEVER. 1 93 

slightest evidence of failure of the heart power is 
exhibited. Black coffee is considered by him to be 
highly valuable as a stimulant, and he insists upon 
its use early. In addition he also urges the employ- 
ment of liquid nourishment in the most concentrated 
form. 

Dr. F. Delafield places the patient upon an ex- 
clusively milk diet, with confinement to bed. For 
an antipyretic he usually prefers cold, either in the 
form of the bath or the pack. Where the bowels 
are inclined to be loose, he administers : 

9- Bismuthi subnit 

Pepsini . . . . aa gr. iii-vi, 

M. Sig. Dose, three times daily, or oftener if re- 
quired. 

If constipation prevails, warm enemata containing 
ox gall or castor oil, are used with good effect. In 
the later stages where this condition exists, he pre- 
scribes the pil. aloes et myrrh. No. i-ii. with much 
benefit. Stimulants are also given, usually whiskey 
or brandy according to indications. 

In cases where dysentery supervenes, he directs 
that the bowels be freely opened with : 

I£. 01. ricini . . . . 3 ii— 3 ss. 

Tinct. opii .... gtt. iii-viii. 

M. Sig. Dose, according to age. 

Following this, he administers the ipecac treatment, 
13 



IQ4 TYPHOID FEVER. 

If much pain is present opium is given to control it. 
After the more active symptoms have subsided, he 
generally finds it of advantage to put the patient on 
the use of the following : 

Ijfc. Tinct. opii deod. . . 3i. m.xx. 

01. ricini §i. 

Mucilag q.s. 

Aq. cinnamomi ad . . . § iv. 

M. Sig. 3 ii-iv. three times daily, according to age. 

On this plan the results are usually very satisfac 
tory. 

In resorting to cold as an antipyretic, Dr. W. 
H. THOMSON directs that the patient be placed in a 
bath of 75°-8o°, and the water gradually cooled down 
to 65 or 6o° ; never lower, however. At the same 
time, cold affusions should be applied continuously 
to the head. Provided the fall is gradual, that is, 
one degree in six, four, or three minutes, the bath is 
continued until the temperature is reduced to ioo°. 
If, however, the temperature falls one degree in two 
and one-half minutes, he stops the bath when the 
thermometer reaches 101 ; for, as a rule, a still fur- 
ther reduction of i° will occur after the bath is dis- 
continued. Again, if the fall in temperature be one 
degree in two minutes, he removes the patient imme- 
diately, whatever the actual temperature may be at 
the time ; for, in such cases, he advises,, there is dan- 



TYPHOID FEVER. 195 

ger of the subsequent fall becoming uncontrollable, 
reaching perhaps 97 , and the patient pass into col- 
lapse. Should such a condition occur at any time, 
he at once orders the patient wrapped in hot blankets, 
hot saucers applied to the epigastrium, and stimulants 
freely administered. Where, from any cause, the bath 
is impracticable, the cold pack is used ; always, how- 
ever, with the same precautions. 

In resorting to either of these measures, Dr. 
THOMSON directs that it be repeated often enough 
to keep the temperature below the point of danger. 
If necessary, he administers one every hour; usually, 
however, two or three daily are sufficient, in which 
case he advises that one should be so timed as to be 
given just before the highest rise of the fever heat, 
generally between two and three o'clock in the after- 
noon. 

Dr. A. H. Smith uses the following method of 
administering quinine by inunction, and finds it es- 
pecially serviceable in children : 

9- Quiniae sulphat. . . . . 3 i. 

Acid, oleic, pur J i. 

01. olivae . . . . 5 & 

Dissolve the quinia in the acid, with the aid of a 
gentle heat, and add the oil. If properly prepared, 
the solution will remain clear. 

Sig. For inunction, to be well rubbed in. 



I96 TYPHOID FEVER. 

This, he advises, may be applied once or twice 
daily to the entire surface, or oftener if required. 

Dr. Austin Flint directs that the child be placed 
in bed and on a milk diet, which is much preferred 
by him. As a rule, alcohol is also given in moderate 
amount, to sustain the strength of the patient, to- 
gether with, in many instances, spts. amnion, aromat. 
For an antipyretic, he sometimes employs quinine in 
large doses, but usually relies more upon cold, in 
form of the bath, pack, or sponging. Of these, how- 
ever, he places greatest reliance upon the wet pack, 
and finds this measure very generally successful, 
while a reduction of temperature does not always 
follow the use of the sponge bath. The cold bath, 
he advises, is not only a troublesome method, but it 
also frequently produces a nervous shock to the 
patient. The results, moreover, from the cold sheet, 
that is to say, by wrapping the body in a wet cloth 
and sprinkling with cold water, he finds equally as 
satisfactory in its effect. 

In many cases occurring at BELLEVUE HOSPITAL, 
where the diarrhoea is excessive, the administration 
of olei terebinthincB, gtt. v-x. every three or four hours, 
is found to be very effectual in controlling it. If 
hemorrhages occur and the patient passes into a 
condition of collapse, turpentine is given three or 
four times daily, in large doses, ice applied to the 



TYPHOID FEVER. I97 

right iliac fossa, and sol. morph. sulpli. {U. S.) admin- 
istered in sufficient amount to afford quiet, together 
with whiskey 3 ii-iii. every half -hour. Sometimes these 
measures are successful in controlling the bleeding, 
and the patient rallies. Or, if the hemorrhage recurs 
and is more profuse, the administration of turpentine 
is increased to every hour or every two hours, and 
the following given : 

5- Ergotini gr. iii. 

Aquae destil. . . . . 3 i. 

M. Sig. m. v-viii. hypodermically. 

Morphia is also used to keep the patient quiet, 
and hypodermics of ether in doses of m. v-xv. once 
or twice daily, ordered, with whiskey as before. By 
these means of treatment, repeated and persisted in 
as occasion requires, the crisis is sometimes tided 
over. 

Where there is much insomnia, with restlessness, 
the following will often cause the child to fall into a 
quiet and refreshing sleep : 

Ipfc. Chloral, hydrat. . . . gr. xl. 
Aquae § i. 

M. Sig. A teaspoonful, repeated in one or two 
hours, to a child of six to eight years. 

Or, in many cases, the combination of potassium 
bromide acts very favorably in controlling the cere- 
bral excitement ; thus : 



I98 TYPHOID FEVER. 

Ijfc. Potass, bromidi gr. x. 
Chloral, hydrat. ... gr. v. 

Aq. anethi 3 ii. 

M. Sig. Dose, every four to six hours, to a child 
of six years. 

Dr. A. L. Loomis directs that particular attention 
be paid to thorough disinfection, both of the stools 
and of the clothes and bedding. The room should 
also be well ventilated, and the temperature kept at 
about 6o°. The diet, he advises, requires especial 
care. This should consist exclusively of fluids, and, 
in his experience, milk is the best article of food, to 
which lime water may be added, if necessary, to allay 
any irritability of the stomach. Regarding broths, 
gruels, etc., he not only objects to their use, but 
considers them often positively harmful. Fruits are 
also especially interdicted by him. In mild cases, 
where the fever does not range very high, he often 
finds that this is all that is needed, beyond an occa- 
sional or frequent sponging of the body with tepid 
or cold water. 

In the more severe forms, his chief indications for 
treatment are to lower the temperature, maintain the 
heart's action, and support the nutrition of the 
patient. As an antipyretic in typhoid fever, he con- 
siders the use of cold in form of the bath, pack, etc., 
one of the most efficient. Ice-bags to the abdomen 



TYPHOID FEVER. , I99 

and to the head, and ice-water enemata are also, in 
certain cases, often found of marked value. Care is 
advised, however, in the use of cold, and in all cases 
he believes it unwise to resort to this measure after 
the second week. 

Quinine in large doses, is found by Dr. LOOMIS to 
render valuable service in the reduction of tempera- 
ture, and in many instances this alone is employed. 
In very severe cases, however, his custom is to use 
both cold and quinine ; that is to say, after the body 
temperature has been lowered to ioi°-i02° by the 
cold bath, he gives an antipyretic dose of quinine ; 
thus maintaining the benefit derived from the bath, 
and postponing the subsequent exacerbation of the 
fever. The following formulae are very highly 
esteemed by him for hypodermic administration : 

]pfc. Quinise disulph. gr. 1. 

Acid, sulphuric. . m. v. 

Acid, carbol m. ii. 

Aquae destil § i. 

M. 

Or: 

9. Quiniae sulphat. . 3i. 

Acid, hydrobrom. . • . 3 ii- 
Aquae destil 3 vi. 

M. 

Of these, the latter has been more recently used 



200 TYPHOID FEVER. 

by him, and is much preferred. After the second 
week, however, should quinine alone, or, in certain 
cases, the use of the cold pack in conjunction, fail to 
control the fever, unless contraindicated by the pulse 
he often finds powdered digitalis, in doses amounting 
to gr. v-x. during the twenty-four hours, in combina- 
tion with quinine, of excellent service. 

For maintaining the heart's action, stimulants are 
given as indicated. But he advises that alcohol 
should be used cautiously, and always with discrimi- 
nation. If its administration is of doubtful advis- 
ability, he directs that it be withheld until the 
indications for its use become stronger ; and in all 
instances, he insists that the effects be carefully 
watched, and its use suspended if no benefit follows. 
At a period of crisis, however, free stimulation is 
often followed by the most gratifying results. 

To meet the special symptoms and accidents oc- 
curring in the course of the disease, various means 
are employed according to circumstances. If the 
headache is very severe, warm water fomentations 
are usually found very beneficial. Should this fail, 
or the headache be followed by severe nervous phe- 
nomena, opium is given cautiously in small doses 
unless contraindicated by the pupil. Or small doses 
of chloral, repeated in two hours if necessary, often 
afford relief. 



TYPHOID FEVER. 201 

A moderate diarrhoea in the early stage, Dr. 
LOOMIS believes may be let alone. Coming on 
during the third or fourth week, he endeavors to 
check it, placing the greatest reliance upon opium 
for this purpose. In his experience astringents, 
either alone or combined with opium, are of little or 
no service. Regarding the use of cathartics in the 
early part of the disease when constipation is pres- 
ent, he advises that they are very likely to do harm ; 
in his opinion they weaken the patient, increase the 
local intestinal lesions, and may cause perforation 
and peritonitis. For the tympanitis, he derives most 
benefit from the use of turpentine stupes. Intestinal 
hemorrhages in the early stage, when mild in char- 
acter, require no treatment, as a rule ; moreover, he 
advises that profuse hemorrhages may often be pre- 
vented by keeping the patient in bed. Coming on 
in the third or fourth week, however, or later, prompt 
measures are immediately resorted to ; semi-narcotism 
is induced by the use of opium, and perfect rest and 
quiet enjoined. Astringents he considers of ques- 
tionable service. The occurrence of peritonitis is 
met by opium, as in cases of local peritonitis. Pul- 
monary complications are treated as usual. 

During convalescence, Dr. Loomis directs the 
strictest attention to the diet. The food is given 
frequently in small amounts, consisting of milk, 



202 



SCARLET FEVER. 



cream, broths, etc., avoiding solids, particularly fruits 
and vegetables, and an advance to the ordinary arti- 
cles of diet gradually and cautiously made. If con- 
valescence is retarded, he finds the use of tonics, cod 
liver oil, and iron, very beneficial. The following is 
a favorite tonic mixture with him : 



Ac. sulphuric, dil. . 


. q. s. 


Aquae . 


. . . I'll 


Tinct. ferri chlor. . 


§ss. 


Spts. chloroformi . 


. 3vi. 


Glycerinse q. s. ad 


. . . Jiv. 



M. 



SCARLET FEVER. 



In mild cases, Dr. Alonzo Clark often finds that 
medicines are not required at all, beyond a moderate 
amount of champagne daily. In severer forms of 
the disease, for the throat affection, he uses calomel, 
silver nitrate, etc.; but in children who are old 
enough, he believes that gargling the throat fre- 
quently with cold water, or cold carbo?iic acid water 
is, in many instances, the best means of treatment. 



SCARLET FEVER. 203 

Where false membrane is present he prefers the 
spray of lime water, thrown into the child's mouth 
during inspiration, and allowing it to run down the 
fauces. If the disease is complicated, by diphtheria, 
he places greatest reliance on the use of the lime 
water spray, continued and repeated as often as indi- 
cated ; this measure is considered exceedingly effica- 
cious. In regard to cold as an antipyretic, he 
recommends the wet sheet as very serviceable, and 
frequently resorts to it, although quinine is employed 
by him with much favor. 

In those cases characterized by hemorrhagic 
eruption, he places the patient under the influence 
of quinine, combined with the free administration of 
the vegetable acids, and an abundance of nutritious 
food. Regarding the kidneys, if oedema occurs, he 
directs that the child be given a hot bath, and imme- 
diately afterward removed to a warm room and kept 
in bed, with sufficient covering to induce a constant, 
gentle perspiration day after day. This plan has 
been found by him to be the most successful method 
of treatment. Dr. Clark also advises that the 
bowels be kept free, not vigorously purged, but that 
a laxative be given as often as necessary, and an 
abundance of drink supplied, together with unirrita- 
ting food. When indicated, an opiate or Dover's 
powder is also administered. 



204 SCARLET FEVER. 

In the severer type of this disease, for the relief of 
the high temperature, Dr. J. Lewis Smith resorts 
to the use of water, cold or lukewarm, applied in the 
form of sponging, the pack, or sometimes the full 
bath, whenever the thermometer registers above 
103 . This he regards as one of the most valuable 
agents that can be employed, for reducing tempera- 
ture and affording general relief to the patient. To 
control the nervous complications, he administers 
large and frequently repeated doses of potassium 
bromide, and usually very effectually. Where, how- 
ever, this fails, he finds that the use of chloral 
hydrate, by the rectum, will almost surely prove 
successful. For this purpose he employs a small 
glass syringe, giving the following : 

Ijfc. Chloral, hydrat. . ... . gr. v. 

Aquae 3 ii. 

M. Sig. To a child of one to three years. 

Regarding inunction, he considers it very service- 
able, especially during the desquamative stage, pre- 
ferring vaseline or carbolized applications. As to 
prophylaxis, he believes there is no remedy which 
can prevent the spread of the disease. 

In the declining stage of scarlatina, Dr. Smith 
often derives great benefit from placing the child 
upon the use of the following : 

1$. Ammon. carb. . , . . 3 ss. 



SCARLET FEVER. 205 

Ferri et ammon cit. . . . 3 ss. 
Syrupi §iv. 

M. Sig. 3 i — ii- every second or third hour. 

If the disease is complicated by diphtheria, he ad 
vises that stimulation is demanded ; in these cases, 
he usually gives brandy in doses of 3 i. every half -hour, 
to a child of three years. 

For prophylaxis, Dr. A. L. LOOMIS employs those 
measures necessary in other contagious fevers. The 
patient is isolated, the room well ventilated, and a 
thorough disinfection of both clothes and excrements 
carefully attended to. Fresh air is, in his opinion, 
of the greatest value as a prophylactic agent. 

His medicinal treatment is chiefly symptomatic. 
As an antipyretic, he considers quinine in large doses 
most efficient. The cold bath is employed, how- 
ever, where the temperature runs high, and the ner- 
vous phenomena present demand the adoption of 
urgent measures. But in all instances, he directs 
that the patient be sponged at frequent intervals ; 
this affords comfort and, at the same time, relieves 
the intense burning which is usually present, espec- 
ially if a tepid saline water be used. When the pro- 
cess of desquamation begins, he advises that a warm 
bath be administered once or twice daily, and carbol- 
izedsoap used over the entire body. As regards the 
use of stimulants, these, he finds, are sometimes in- 



206 SCARLET FEVER. 

dicated even from the early stage of the disease, par- 
ticularly in cases where marked nervous symptoms 
are present, together with failure of the vital powers : 
and indeed, in certain instances, free stimulation con- 
stitutes almost his sole reliance. 

He also directs that especial guard be made against 
complications. These are carefully watched for, and 
met by suitable means. For the throat, he finds 
cold carbonic acid water, or pieces of cracked ice. 
most serviceable : particularly in the early stage. 
Later on. when there is considerable infiltration pres- 
ent, he prefers the use of hot applications extern- 
ally, covered with oil-silk, and combined with steam 
inhalations and warm gargles^ as of greatest benefit. 
If ulcers are present, these are treated very satisfac- 
torily with carbolic acid ox potassium chlorate, in form 
of the spray. Anodyne applications, by means of 
the spray, are also found to give much relief. 

When evidences of kidney lesions are manifest. 
Dr. LOOMIS resorts to the immediate application of 
cups, three or four in number, followed by the use of 
hot fomentations. Combined with these measures. 
he also directs that the body be covered with flannel 
and hot baths employed, together with the internal 
administration of diuretics. Of the latter he pre- 
fers digitalis. Frequent draughts of water are also 
given. If these fail in reducing the anasarca, he then 



SCARLET FEVER. 207 

administers calomel in combination with the diuretic, 
continuing this for two or three days, and often with 
the most gratifying result. If convulsions are immi- 
nent, or present, opium is given, affording relief to 
these symptoms as well as producing diaphoresis, 
which is sometimes of vital importance in this con- 
dition. 

For a gargle, Dr. G. M. LEFFERTS uses the fol- 
lowing : 

9- Glycerit. ac. carbol. . . 3 i — ii- 

Aquae § x - 

M. 
Or: 

5. Acid, acetic. . 3 h'ss. 

Glycerinae .... 3 iii. 

Aquae §x. 

M. 

Dr. F. A. Burrall finds the following very ser- 
viceable : 

5- Acid, carbol. . . . gr.xx. 

Glycerinae . . . 5 i. 

Sodii chloridi ... 3 i. 

Aquae ad .... 5 vn i- 

M. Sig. Gargle. 

Dr. D. Lewis has used the infusion of digitalis 
in the treatment of scarlet fever, in a large number 
of cases, and with markedly beneficial and uniformly 



208 SCARLET FEVER. 

successful results. By this means, not only is the 
frequency of the pulse lessened, the temperature 
lowered, and its effects on the circulation of the kid- 
neys exhibited, but he also finds that the tendency 
to exudation in all glandular tissue is reduced to the 
minimum, by its use. For these cases, he considers 
the infusion of the best English leaves, the most re- 
liable preparation. The tincture is, in his experience 
unsatisfactory. In regard to the administration, he 
directs that this be commenced at the earliest 
possible stage of the disease, before those tissue 
changes have occurred which it is intended to 
prevent as well as cure. He usually gives the 
following : 

9. Inf us. digitalis . . . . 3 i. 

Sig. Dose, every four hours, to a child of five 
years. 

This, he finds, is a safe and generally an efficient 
dose. Should, however, the pulse and temperature 
be unaffected by it, he increases the amount to even 
3 ii. if necessary, but advises that its effects be care- 
fully watched, and the dose reduced as soon as the 
desired result is produced. Unless the pulse be- 
comes less frequent than it should be, he continues 
the administration two or three times daily, until the 
end of the third week. This plan of treatment has, 
in numerous instances, caused a decided fall in the 



SCARLET FEVER. 20O, 

pulse and temperature within twenty-four hours, and 
the most favorable results have followed. 

For the throat affection, Dr. Lewis prescribes the 
following, a favorite with him and usually very ef- 
ficient : 

5- Potass, chlorat 3 i- 

Tinct. ferri chlor. . . . 3 ii. 

Glycerinae . . . . § i. 

Aquseq.s. ad .... §viii. 

M. Sig. A teaspoonful every half-hour. 

If exudation occurs in the fauces, he also uses this 
mixture applied by the atomizer every twenty min- 
utes. A water sponge bath is also given more or less 
frequently, according to the degree of the fever, and 
inunctions of olive oil applied over the entire body 
at least twice daily, and continued until desquama- 
tion is complete. The diet he requires to be strictly 
of milk, particularly on account of its diuretic effect. 
In his experience, under this treatment, no case of 
suppuration of cervical or other glands has oc- 
curred. 

Regarding the nephritis, Dr. A. JACOBI has suc- 
ceeded in curing a number of cases by the following 
method. He confines the, child to bed and directs 
that a hot bath be given twice daily, to produce free 
diaphoresis ; or sometimes the hot pack is used in- 
stead. In other instances, where the heart's action 
14 



2IO SCARLET FEVER. 

is good, he employs the hypodermic injection of pi- 
locarpine, given two or three times in the twenty-four 
hours ; thus inducing an abundant perspiration. In 
conjunction with this, he also administers alcohol in 
sufficient quantity to counteract the depression on 
the heart, caused by the pilocarpine. By this means, 
he occasionally gives as many as eight injections in 
twenty-four hours, always taking care to see that the 
child is well stimulated. This heroic plan is, how- 
ever, not advised by him in all cases. In addition to 
the pilocarpine, he sometimes prescribes gallic and 
tannic acid in doses of gr. v-xv., daily, with very 
favorable effect. Toward the later stages, he finds 
the administration of iron often of great service, 
when there is much albumen in the urine. The cau- 
tious use of the salines is also resorted to, keeping 
the bowels gently open. 

At the New York Hospital, the following solu- 
tion of pilocarpine is kept for hypodermic use : 

IjL Pilocarpiae mur. . . . gr. i. 

Aq. destil. carbol. . . . m. 1. 

M. 

Dr. J. H. RlPLEY finds that in the majority of 
cases of scarlatinal nephritis the tendency is to re- 
covery. His treatment varies somewhat according 
to the special symptoms, and the different complica- 
tions arising in individual cases. In mild attacks, he 



SCARLET FEVER. 211 

directs that the child be put to bed at once, in a room 
the temperature of which is maintained at 70°-75°, 
and the atmosphere kept in a moistened condition. 
All exposure to cold is also to be carefully avoided. 
A mild laxative is given, usually a combination of 
magnesia, senna and rhubarb, keeping up a somewhat 
free action of the bowels ; the use of hydragogues 
is, however, objected to by him. A diaphoretic is 
also administered, for which purpose he prefers the 
liqtwr amnion, acetatis. In addition to these meas- 
ures, the diet is made simple and nutritious, alter- 
nating with milk, beef-tea, buttermilk, broths, etc. 

In severe cases, where there is partial or complete 
suppression of the urine, he discountenances the use 
of active diuretics in the earlier stage of the disease, 
with the view of washing out the debris. In his ex- 
perience the opposite result, with increased conges- 
tion of the already surcharged kidney, obtains, and 
he considers their employ worse than useless.- When, 
however, the disease is subsiding, he then administers 
these remedies with marked benefit. His plan of 
treatment, and on which he places the greatest reli- 
ance, is to induce a free perspiration by means of the 
moist, warm pack, applied for at least two hours. 
This measure he finds highly efficacious, and believes 
it to be superior to any other means. In bad cases, 
he repeats the pack several times during the twenty- 



212 SCARLET FEVER. 

four hours, and, if necessary, every day for a number 
of days. In this respect, he cautions that great care 
must be exercised, to avoid any exposure to cold 
during the intervals. Should the child prove refrac- 
tory, force is used ; the hands and arms are tied and 
the coverings secured by safety pins, or other means ; 
or, in many instances, he prefers to put the child 
under the influence of morphine, for this purpose. 
On removing the patient from the pack, the body is 
thoroughly rubbed with a coarse towel until the sur- 
face is dry. Regarding the warm bath, Dr. Ripley 
objects to its use on account of the general tendency 
to cause exhaustion, if prolonged or frequently re- 
peated. Moreover, he finds that many children 
are greatly afraid of it, and alarming syncope is 
often produced by this means. In older children, 
the hot air bath is occasionally substituted for 
the pack, although he considers it far less prac- 
ticable. . 

Dry cupping is also resorted to, but he directs that 
the cups be removed before stagnation and rupture 
of the capillaries occur. As a rule, they are not al- 
lowed to remain on longer than five or ten minutes, 
and in delicate and nervous children he usually finds 
it better to administer chloroform, while applying 
them. In some cases, instead of cups, but more fre- 
quently following them, he applies large hot poultices 



SCARLET FEVER. 21 3 

over the parts, often mixing digitalis leaves with the 
meal, very efficaciously. 

For internal medication, after perspiration is in- 
duced by these means, Dr. Ripley keeps up a gen- 
tle moisture of the skin by administering the following: 

9. Ext. jaborandi fl. . . gtt. v-xx. 
Aquae ...... q.s. 

M. Sig. Dose, every two hours, according to age. 

This, he finds, is a much more serviceable way of 
giving the drug, than by larger doses and at longer 
intervals. If the temperature is high and the pulse 
full and strong, he gives tinct. veratri viridis in small 
doses every two hours, with marked benefit, and also 
with good effect on the kidneys. Aconite he finds 
less certain in its action, although not so likely to 
cause vomiting, and attended with less danger^from 
prolonged use. If there is much restlessness pres- 
ent, morphia is employed. 

Should excessive oedema occur, with general an- 
asarca, and diaphoresis and catharsis prove unavail- 
ing, a few small punctures are made in the lower part 
of the legs, and often very successfully in causing re- 
moval of the fluid. As a rule, however, he rarely 
finds this procedure necessary in acute cases. Where 
pulmonary cedema occurs, he resorts to immediate 
dry cupping, together with the application of large 
hot poultices over the entire thorax. 



214 SCARLET FEVER. 

In treating the uraemic symptoms most common in 
children, viz. : gastric irritation, painful and exhaust- 
ing diarrhoea, extreme restlessness, etc., Dr. Ripley 
cautions against the danger of inducing excessive 
purgation, especially by mercurials ; thus increasing 
the irritability of the stomach, impairing the nutri- 
tion, and causing loss of strength. In his experience, 
producing more than two or three liquid passages 
daily is harmful. For the gastric trouble, he ad- 
vises the most careful attention to diet, giving the 
food in small quantities at a time; a teaspoonful 
every fifteen minutes, he finds, will be retained, when 
a tablespoonful every hour is vomited. For this pur- 
pose, koumyss, milk and lime water, clam broth, or 
grated smoked-beef, are preferred by him. If pros- 
tration is a prominent symptom, brandy and ice-water, 
or champagne, is given as indicated. Or, in many 
cases, he considers the following almost a specific, 
prescribing it with greatest benefit : 

IJ. Sol. morphias sulph. (U. S.) . gtt.v-xx. 
Sig. Dose, every three or four hours. 
This is administered either hypodermically or by the 
stomach. Or, sometimes a mixture of a few drops 
of chloroform with paregoric and syrup of acacia, 
does very well. In others, he uses the following 
most satisfactorily : 

9. Chloral, hydrat. . . . gr.v-xv. 



SCARLET FEVER. 215 

Aquae gss-i. 

M. Sig. Dose, by the rectum. 

To control the diarrhoea, he generally begins with 
a small purgative dose of calomel and compound 
jalap powder, and then employs a mixture of opium, 
tannic acid and cinnamon water, to hold it in check ; 
avoiding, however, any tendency to produce consti- 
pation. If dysentery is present, he first administers 
a large enema of hot water, thoroughly washing out 
the gut and relieving the congestion, after which he 
gives the following : 

]pL Tinct. opii . . . gtt.iii-x. 

Aquae ferv. . . § ss * 

M. Sig. Dose, as an enema, according to age. 

This latter he repeats after each passage, the hot 
water injection being employed two or three times 
daily. Where the laudanum enema is not retained, 
opium in some form, either alone or with calomel, 
is employed. 

For the restlessness, Dr. RlPLEY usually finds this 
symptom yield promptly to chloral hydrate particu- 
larly when combined with small doses of morphine. 



2l6 MEASLES. 



MEASLES. 



For mild cases, Dr. Alonzo Clark finds that 
hardly any treatment is necessary. The home 
remedy, catnip tea, he considers about as good as 
anything. In the severer forms of the disease, asso- 
ciated with complications, more urgent measures are 
adopted. In the hemorrhagic variety, he adminis- 
ters iron and the vegetable acids, together with the 
supporting effects of quinine and nutritious food. 
Should gangrene occur, quinine, in his experience, 
renders the greatest service, combined with the free 
exhibition of stimulants. In the malignant form, 
however, he finds medicinal remedies have little or 
no influence over the disease. Ergot, he thinks, may 
possibly afford some benefit, from its control over 
the capillary circulation. Cold, applied both to the 
body and to the head, he uses very effectually as an 
antipyretic, when called for. Should anasarca occur, 
he resorts to the same measures employed in his 
treatment of scarlatina. For the ophthalmia which 
sometimes follows an attack of measles, Dr. Clark 
recommends the application aroflnd the eyes of an 
ointment of veratria, thus : 

IjL Veratriae gr. viii. 



MEASLES. 217 

Adipis prep. . . . 5 i. 

01. olivae 3 ss. 

M. 

This he uses with the utmost satisfaction. 

As prophylactic measures, Dr. A. L. LOOMIS 
directs that the child be placed in a separate room, 
and an abundance of fresh air obtained*; together 
with disinfection of the clothing, attention to clean- 
liness, etc., and good hygiene. In mild cases, very 
little is done in the way of treatment. The room 
is darkened, good ventilation secured, avoiding 
draughts and all exposure, and the patient placed 
on a milk diet with occasional broths. The fever, 
where it is slight in degree, is disregarded, or con- 
trolled by frequent tepid sponging, which also allays 
the itching and burning of the skin. Where there 
is much thirst, this is relieved by permitting the 
child to drink freely of cold water, in small amounts. 
In these cases, as a rule, he objects to the use of 
stimulants in the early stage, and advises that very 
serious results may follow their administration. 
When, however, prostration is marked, and with 
the typhoid condition present, the strength of the 
patient must be supported, and stimulants are often 
required from the onset of the disease. If there 
is considerable restlessness, opium is given in small 
doses ; usually Dover's powder. 



2l8 MEASLES. 

Where the disease runs a severe course, and the 
fever calls for more active measures, Dr. Loomis 
places most reliance upon quinine, as an antipyretic. 
He uses the sponge bath, however, very effectually, 
but objects to the cold bath from fear of pulmonary 
complications. These, he advises, should in all 
cases be especially guarded against ; and when bron- 
chitis is present, or as soon as laryngeal symptoms 
are manifest, and respiration interfered with, he 
immediately resorts to inhalations of vapor, and 
continues them so long as evidence of any obstruc- 
tion to the breathing exists. The importance of 
this measure, he believes, cannot be over-estimated. 

The following is a most excellent cough mix- 
ture, and is used very extensively with children at 
Bellevue Hospital (also at the Infants' Hos- 
pital) : 

Ijfc. Tinct. opii camph. 

Spts. ammon. arom. . . . aa 5 i. 
Ext. ipecac, fl. . . 3 ss. 

Syr. pruni virg § i. 

Aquae q.s. ad .... 5 vn i- 

M. Sig. A teaspoonful. 

In cases of so-called German Measles, or Epi- 
demic Roseola, his treatment consists mainly in 
careful attention to the diet, etc., and the avoidance 
of exposure. Any catarrhal affections which are apt 



VARIOLA. 219 

to arise in the course of the disease, are carefully 
guarded against, and when occurring, receive prompt 
attention. For the itching, which is sometimes in- 
tolerable, he finds sponging with tepid water very 
efficient, as well as in relieving the febrile symptoms. 
In certain cases, he also prescribes tonics, iron, and 
cod liver oil when indicated, with good effect, but 
usually he finds that the disease runs a mild course, 
and recovers with no untoward symptoms. 



VARIOLA. 

(small pox.) 



Dr. J. N. McCHESNEY (late Attending Physician 
to the Hospital for Contagious Diseases) finds that 
mild, discrete cases require little or no treatment, 
except the usual attention to hygiene and diet. 
This latter, in the early period of the . disease, is 
made simple, consisting of milk, rice, cornstarch, 
etc. In these patients, when contact with other 
persons can be prevented, exercise in the open air is 
also found beneficial. 

During the first few days, in the early stage, he 
administers cooling acidulated drinks for the fever, 



220 VARIOLA. 

together with sponging the body with cool or tepid 
water; this also serves to render the patient more 
comfortable. Quinine he considers of little or no 
use as an antipyretic, and finds, moreover, that it is 
rejected, as a rule, and only adds to the irritability 
of the stomach. If constipation is present, an 
enema or mild laxative is given, avoiding active 
catharsis. For this purpose, the citrate of magnesia 
is found very agreeable and efficient ; or sometimes 
seidlitz powders, or one of the aperient waters, are 
used. These also tend to relieve the nausea and 
vomiting. Where diarrhoea is prominent, mistura 
cretas is ordered, either alone or with one of the 
vegetable astringent tinctures. Or, in many cases, 
the following is used by him with the greatest satis- 
faction : 

JL Ext. coto fl m. x. 

Syrupi aromat. . . . q. s. 

M. Sig. Dose, ever}'- half hour. 

This he gives until three doses have been taken, 
which is usually found sufficient. The nausea and 
vomiting, however, is sometimes very persistent and 
distressing. To relieve this symptom, in some in- 
stances small lumps of ice, swallowed whole, are of 
service. In others, lime water, or carbonic acid 
water in small quantities is most efficacious. Or, 
morphia hypodermically over the region of the 



VARIOLA. 22 1 

stomach is often used with the greatest success. 
Counter-irritation, in the shape of mustard poultices, 
though usually effectual, is objected to on account 
of inducing vesication. For the headache, he applies 
cold cloths ; or, occasionally hot cloths, as hot as 
can be borne, are more serviceable. If there is 
much restlessness and delirium, he gives the bro- 
mides combined with chloral in an aromatic vehicle, 
with good effect ; or, if necessary, morphia is used. 
To relieve the intense pains in the back, various 
means are employed. Sometimes the sponging and 
bathing resorted to for the temperature, is found 
beneficial. Or the application of a sponge wrung 
out of hot water, repeated as soon as it cools, often 
affords relief. At times, however, hypodermics of 
morphia are needed. With the appearance of the 
eruption, he finds that for a few days these mild 
cases call for no treatment whatever ; as the symp- 
toms are greatly diminished in intensity, and in 
some instances are altogether absent. 

In the more severe attacks, to relieve the cedema 
of the face and eyelids Dr. McCHESNEY applies 
hot water compresses constantly, changing them at 
frequent intervals. The smarting pain, generally 
present over the entire surface of the body, is 
treated by the application of cold vaseline, which is 
much preferred by him to the numerous ointments, 



222 VARIOLA. 

creams, etc. For the throat symptoms, various 
gargles are at times employed ; e. g. y flax-seed tea, 
solutions of potassium chlorate, alum, and borax. 
In his experience, however, bromo-chloralum has 
given the greatest satisfaction, usually affording 
quicker and more lasting relief. Small pieces of 
cracked ice, held in contact with the mucous mem- 
brane, are also very grateful. Externally, he uses 
hot moist applications with benefit ; together with 
steam inhalations, and spraying the throat with 
astringent solutions, which often give much com- 
fort. For the conjunctivitis, in most cases a weak 
solution of alum answers very well. When, how- 
ever, there is also pain and photophobia he employs 
the following very effectually : 

IJ,. Atropise sulph. . . gr. ii-iii. 

Aquae . . . . . § i. 

M. Sig. To be dropped into the eye. 

Where the pain from distension of the vesicles on 
the hands and feet is intense, he finds that soaking 
the part in hot water for fifteen or twenty minutes, 
followed by puncture of the vesicles and escape of 
their contents, affords most relief. In confluent 
cases, when the bullae break, marked benefit is 
derived from dusting the raw surface with a powder 
of bismuth and zinc oxide ; or sometimes lycopodium 
is used for this purpose. 



VARIOLA. 223 

In cases marked by the early appearance of great 
prostration and restlessness, stimulants - are freely 
administered, combined with nutritious food. When 
extensive suppuration is evident, the strength of the 
patient is supported by the early use of stimulants 
resorted to, according to indications, and continued 
until convalescence is fully established. 

For an antipyretic in the stage of secondary fever, 
Dr. McChesney has tried quinine in large and fre- 
quent doses, but with poor results ; hence, he greatly 
prefers cold, in the form of sponging, or the wet 
pack, and places the utmost reliance upon its use. 
This, he finds, not only controls the temperature, 
but also the delirium and restlessness. In adminis- 
tering it, he always begins with water that is slightly 
tepid, and continues using it until the temperature 
falls to about the normal. In weak patients, the 
addition of alcohol to the water is often made with 
advantage. If anodynes are required, he finds the 
bromides or chloral very serviceable. Caution is 
advised, however, in their use, particularly in cases 
where there is an abundant expectoration of viscid 
mucus ; as, during sleep, the accumulated secretions 
may pass into the air-passages in sufficient amount 
to cause asphyxia. During this stage, the diet is 
made of the most nutritious character, consisting of 
milk, beef-tea, broths, eggs, etc. Stimulants are 



224 VARIOLA. 

also given, alone, or in the form of milk punch and 
the like. 

When the pustules rupture, to relieve the burning 
and itching of the skin, he finds carbolized baths 
most effectual, followed by the free use of vaseline. 
To correct the offensive odor, he much prefers a 
solution of potassium permanganate, or bromo-chlo- 
ralum, to carbolic acid. Occurring in the hot weather, 
he advises that great care be taken in preventing the 
flies from depositing their eggs in the pustules, and 
which, when developed, may cause serious results. 
For this purpose he finds the free application of a 
strong solution of permanganate of potassium the 
best method, not only of destroying them, but of 
preventing their return. 

During the period of desquamation, especially if 
suppuration has been abundant, he administers tonics, 
iron, quinine, and the bitters, combined with nutri- 
tious food and the use of stimulants. At this time, 
frequent warm baths are found very agreeable, as 
well as assisting in the removal of the crusts. In 
cases where the scabs about the face and nose are 
unusually adherent, and tend to prolong and increase 
the ulceration, he directs that they be softened with 
hot water, or vaseline, and removed. After which, 
he makes direct application to the bottom of the 
ulcer of the following : 



9- 





VARIOLA. 




Iodoformi 


... 


gr. xxx. 


Bals. tolutan. 


. 


. . Si. 



22$ 



M. 

By this method, he has obtained the most uniformly 
gratifying results. In regard to the prevention of 
pitting, Dr. McCHESNEY has tried every means 
recommended by various authorities for this object ; 
but it is his experience that if the pustules are super- 
ficial, the pitting will be slight, while if the true skin 
is involved, this will occur in spite of every endeavor. 
During convalescence the hygienic surroundings 
receive the most careful consideration ; plenty of 
fresh air is secured, at the same time avoiding any 
exposure, from the risk of pulmonary complications. 
The following, from Bellevue Hospital, will be 
found very useful if broncho-pneumonia sets in : 

9. Ammon. carb 3 ss. 

Syr. senegae . . . . 3 iv. 

Syr. ipecac. . . . 3 ii. 

Syr. tolutan. . . . 3 iv. 

Ext. glycyrrh. . . . 3 ss. 

Aq. cinnam. q. s. ad . . . § iv. 
M. Dose : A teaspoonful. 

Dr. Alonzo Clark directs that the patient be 

placed in a large, well-ventilated room provided with 

an open fire place, and from which the carpets and 

all unnecessary furniture should be removed. The 

15 



226 VARIOLA. 

strictest attention should also be given to disinfec- 
tion. His medicinal treatment is in the main symp- 
tomatic. He advises that in very many cases of 
small-pox, where the tendency is to recover, but 
little treatment is necessary. If there is much ex- 
haustion, he administers stimulants as in typhoid 
fever. Where a wide erysipelatous inflammation is 
present, he directs the room be kept cool, so that the 
coldness of the air may modify the action of the 
inflammatory disease. Should the patient exhibk 
great restlessness, opium is given in some form, to 
afford quiet. If oedema glottidis occurs, scarification 
is resorted to. 

Regarding the subsequent cicatrization, he finds 
that if early in the disease the vessels be pricked 
with a lancet, and kept empty, such a condition may 
sometimes be avoided. Or, the application of the 
old mercurial plaster to the face, he occasionally uses 
with more or less success in preventing the pitting. 
Another method recommended by Dr. Clark, is by 
the use of a mixture of collodion and animal black, 
applied with a brush over the face. 

The following is the formula used at the Chil- 
dren's Hospital, Paris, applied in the form of a plaster, 
and is considered to be quite successful to prevent 
the pitting : 

5- Ung. hydrarg. . . . part. xxv. 



VARIOLA. 227 

Cerse flavae .... part. x. 

M. Picis nig. .... part. vi. 

In the early stage of the disease, Dr. A. L. 
LOOMIS directs his treatment mainly to the attend- 
ant symptoms. If the thermometer shows any 
marked degree of fever, he controls it by the use of 
cold, in the form of the bath or pack ; or by the ad- 
ministration of quinine in large doses. When there 
is much vomiting, iced carbonic acid water is given 
with good effect ; or if with this symptom there is 
associated considerable restlessness, opium is resorted 
to. Where constipation is present, cold water cne- 
tnata are found very serviceable, as well as having 
a cooling effect on the blood. For the headache, 
when severe, cold in the shape of ice-bags, or com- 
presses, is applied with benefit. 

With the appearance of the eruption, the means 
resorted to by him depend upon the character of this 
stage. Mild cases of discrete form, he finds, call for 
little or nothing in the way of treatment. Should, 
however, the eruption be slow in development, or 
late, with high temperature, he finds that a warm 
bath for a quarter of an hour or longer often hastens 
its development. When desiccation is reached he di- 
rects that warm baths, followed by oiling of the body, 
should be administered even- one or two days. In 
the severer forms, where there is great depression, 



228 INTERMITTENT FEVER. 

delirium, the typhoid state, etc., and especially dur- 
ing the suppurative stage, stimulants are freely ad- 
ministered and often with the most gratifying effect. 
Where the delirium is very marked, opium is also 
given in combination. 

In regard to the pitting, Dr. LOOMIS has tried 
a number of methods to prevent its occurrence, but 
finds that the best results obtain from opening the 
vesicle before it becomes a pustule, and dressing the 
part simply with cold water. 

Dr. W. H. Thomson recommends the following 
as a very excellent tonic formula, when indicated : 
5- Ferri et ammon. cit. . . 3 i. 

Ammon. carb. . . . gr. xxx. 

Tinct. gentian, co. 
Tinct. quassiae . . . aa 5 ii. 

Syrupi ' § iss. 

Aquae q. s. ad . . . § viii. 

M. Sig. One to two teaspoonfuls. 



INTERMITTENT FEVER. 



Dr. Austin Flint gives quinine at any stage of 
the disease, until slight signs of cinchonism are de- 



INTERMITTENT FEVER. 229 

tected. He advises beginning with small doses, to 
ascertain the tolerance for the drug ; usually thus : 

5>. Quiniae sulph. . . . gr. i-iii. 
Sig. Dose, every four hours. 

Having discovered this, he continues the adminis- 
tration in full doses until the paroxysm no longer oc- 
curs, and in smaller doses for a long time afterward. 
He generally gives it by the mouth, or, in other 
cases, by the rectum in double the quantity by means 
of enemata. Iron is also employed for the anaemia 
attending the disease. For the enlarged spleen, he 
finds that nothing so speedily diminishes the size as 
quinia. 

Dr. Alonzo Clark considers the following com- 
bination a most excellent one, and of peculiar value 
in many cases : 

5. Quiniae sulph. . . . gr. xx. 

Pulv. capsici gr. vi. 

Pulv. opii gr. i. 

M. 

This he has given in very obstinate cases of long 
standing, where the spleen has been much enlarged, 
and with marked benefit. In all cases, however, he 
administers quinine daily for some time, whether 
signs of intermittent fever present themselves or not. 
Where cachexia is also more or less prominent, he 
administers iron, usually in form of the carbonate 



230 INTERMITTENT FEVER. 

with much satisfaction. For this purpose the 
chocolate iron lozenges, which contain fcrri protocar- 
bon. gr. zi'ss., are greatly preferred by him. The ad- 
vantage of this form of iron preparation, he advises, 
is that the chocolate renders the iron quite tasteless, 
and very agreeable to take. 

Dr. F. A. Burrall directs attention to a condi- 
tion occurring in children of from one to two years, 
sometimes older, which he finds is not infrequently 
mistaken for malaria, but which is regarded by him 
as acute blood poisoning due to defective hepatic 
secretion. [In the milder forms, he advises, the 
child suddenly or gradually, while in usual health, 
becomes indisposed, pale or perhaps faintly yellowish, 
has a dry and somewhat warmer skin than natural, 
and an irritable stomach with constipation, or scanty 
light-colored stools. If this condition is not arrested 
it tends to further development, when the surface 
becomes decidedly yellow and dry, the pulse frequent 
and the temperature elevated, with headache more 
or less severe, grating of the teeth, and perhaps 
delirium. The appetite is sometimes voracious, 
sometimes lost. The irritability of the stomach 
varies from nausea to persistent, and occasionally 
apparently uncontrollable, vomiting. Repeated 
chills usually occur, and in some cases sore throat is 
present.] In these attacks, his indication for treat- 



INTERMITTENT FEVER. 23 1 

ment is to promote the excretions. To accomplish 
this, he gives : 

9- Hydrarg. chlor. mit. . . gr. -i~£. 

Sig. Dose, every hour, placed dry upon the 
tongue. 

The administration is then repeated until four or 
five doses have been taken, or the bowels begin to 
act. This plan, he finds, is usually attended with 
marked success. 

Dr. J. C. Peters has also met with a number of 
cases of supposed malaria, of the class described by 
Dr. BURRALL and has likewise obtained good 
results from the use of calomel. In his experience, 
however, other remedies answer an equally good, 
and perhaps better, purpose. The following is his 
favorite formula for these children : 

9- Tinct. aloes (U. S.) . . part. iv. 
Ext. glycyrrh. fl. . . pars i. 

M. Sig. m. xv-xxx- 3 i. according to age. 

In many so called " mixed " cases of malaria, 
which do not always yield promptly to quinine, he 
finds that by a combination with one of these, the 
quinia acts more favorably than when given without 
an adjuvant. 

Certain cases of malaria occurring in older children, 
have also been noticed at the New York Hospital, 
in which vesical irritability with nocturnal inconti- 



232 INTERMITTENT FEVER. 

nence of urine, pubic pain, etc., have been present ; 
and in some instances even simulating vesical calcu- 
lus, from which, moreover, careful judgment is often 
necessary to diagnosticate. In these cases, the 
patient is placed on the following treatment with 
very gratifying results. Laxative pills are ordered, 
one to be taken three or four nights in succession, 
together with quinice snlph.' gr. iii-v. two or three 
times daily. In conjunction with this, a pill con- 
taining^^-/, belladonnce gr. \ is also administered three 
times daily. 

In cases where anaemia is very marked, the follow- 
ing is often found of great benefit : 

9-. Ferri et potass, tart. . . gr. v. 

Liq.- potass, arsenit. . . m. ii. 

Potass, bicarbon. gr. x. 

Tinct. nucis vomicae . . m. v. 

Aquae ad . . . . • 3 i- 

M. Sig. To be taken in a wineglass of water, be- 
fore eating. 

During the paroxysm, Dr. A. L. Loomis directs 
that the patient be put to bed, and, in the cold stage, 
well covered with blankets, bottles of hot water ap- 
plied to the surface of the body, and hot drinks 
freely supplied. As the hot stage comes on, these 
are gradually removed, and cold drinks administered. 
The nausea and vomiting he usually relieves by 



INTERMITTENT FEVER. 233 

means of opium. In the sweating stage, no treat- 
ment is called for. During the interval, he gives a 
moderately large dose of quinine at the close of the 
third stage, and double the quantity two hours before 
the occurrence of the next paroxysm. Where the 
stomach is too irritable the hypodermic method is 
used ; for this purpose, the following combination is 
greatly preferred by him : 

9. Quinise sulphat 3 i. 

Acid, hydrobrom. . . . 3 ii. 

Aquse distill. . . . 3 vi. 

M. 

In very nervous cases he often gives opium in 
combination with good effect. A mild state of 
cinchonism is then kept up for several days ; after 
which he directs that the patient should be seen one 
month after the first paroxysm, as the chills are very 
liable to return at this period, and cinchonism should 
be again produced. When quinia alone fails, because 
of an hyperaemic condition of the liver and spleen, 
he finds that calomel in full doses, combined with 
the former remedy, will often prove of greatest effi- 
cacy. Arsenic he considers of little or no service. 

In those cases where the infection has assumed a 
chronic form, Dr. Loomis advises that the patient 
be removed to a warm, dry, non-malarial region, and 
all exposure carefully avoided. Tonics he finds very 



234 INTERMITTENT FEVER. 

useful. Iron is given with the quinine, and often 
proves exceedingly serviceable when anaemia is 
prominent. Where the liver and spleen show much 
enlargement, he considers the iodide of iron in com- 
bination with cod liver oil particularly valuable. He 
also advises that the bowels receive careful atten- 
tion, and constipation, when present, relieved by 
rhubarb or aloes. Arsenic is often found of benefit, 
especially in cases where the above means have 
failed. The administration of the drug, he advises, 
must be watched with great care, and immediately 
stopped on the appearance of any constitutional 
effects. Hygienic and dietetic regulations also 
receive proper care. A nutritious diet is con- 
sidered by him to be of the highest importance, in 
these cases. 

At Bellevue Hospital the following means are 
often employed, in cases of older children, to pre- 
vent the chill of malaria. In a large number of 
instances, chloroform and whiskey are often found 
very efficacious ; given thus : . 

1$. Spts. chloroformi 

Spts. frumenti . . . aa 3 ii-iii. 

M. Sig. Dose. 

Or, the following is administered, and not in- 
frequently entirely prevents the occurrence of the 
chill : 



TYPHUS FEVER. 235 

9. Amyli nitriti . . . gtt. iii-iv. 

Sig. To be inhaled every half-hour, from a 
cloth or sponge. 

In other cases, pilocarpine in doses of gr. -£ 2 -\ 
hypodermically is often of excellent service. For the 
administration of quinine by hypodermic injection, 
the following formula is very generally employed at 
this hospital : 

^. Quiniae sulphat. . . gr. lxxx. 

Aquae § i. 

Acid, sulphuric, dil. . . q. s. 

Heat to boiling et add. 
Acid, carbol. . . . . gr. v. 

M. 



TYPHUS FEVER. 



Dr. Austin Flint places the patient on a diet of 
milk, eggs, broths, etc., advising, moreover, that 
these should not be given at too short intervals. 
The system is also supported by stimulation, par- 
ticularly where any undue depression is present. 
Or, if there is any doubt as to the advisability of its 
administration, he directs that the alcohol be given 



236 TYPHUS FEVER. 

and its effects closely watched. Brandy is usually 
preferred by him, in small doses at intervals of one 
or two hours, thus determining the amount required 
daily ; in all cases, however, its toxical effect should 
be carefully avoided. 

For the high temperature, he places greatest reli- 
ance upon cold as an antipyretic, although in some 
instances quinine in large doses is found very ser- 
viceable ; or, at times, aconite or veratrum viride is 
used. In the application of cold he considers the 
wet sheet the best method for continued use. 
Where the bath is employed, if it gives rise to no 
unpleasant symptoms, he directs that it be con- 
tinued until the temperature is reduced ; always 
bearing in mind that a fall of one degree or more 
may be expected after removal from the bath. 
When the temperature again rises above 103 , the 
process is repeated. Regarding this plan of treat- 
ment, he finds that unless it be systematically car- 
ried out, its merits cannot be fairly judged. The 
sponge bath is also used very effectually, besides 
affording comfort to the patient. 

For the headache, cold, by means of the douche 
or the wet napkin, applied to the head after having 
cut the hair close, is found of marked benefit. This 
is also of service in quieting the delirium, when 
active, combined with the internal use of opium, 



TYPHUS FEVER. 237 

either alone or with small doses of tartar emetic. 
Where the delirium is mild in character, no especial 
treatment is required. If insomnia is a prominent 
symptom, this he controls by the use of the bro- 
mides ; or sometimes opium is necessary. 

To relieve the nausea and vomiting, Dr. Flint 
advises that the greatest care be exercised in the ad- 
ministration of the food, as he frequently finds this 
symptom due entirely to improper management of 
the diet. In other instances bismuth and opium 
powders are given with good effect. This also 
serves to control the diarrhoea, if present. The fol- 
lowing is used at Bellevue Hospital : 

9- Bismuthi subnit. . . gr. iv. 

Pulv. ipecac, co. ... gr. i. 

M. Sig. Dose. 

Where, however, there is diarrhoea of a mild form, 
it may be let alone ; in his opinion, more than three 
or four passages daily would indicate the resort to 
measures for suppressing it, when astringents, tur- 
pentine, etc., may be needed. For the constipation 
which is usually present, enemata are employed. 

In addition to these means of treatment, the ob- 
servance of good hygiene, cleanliness, plenty of fresh 
air, etc., receive the most careful attention. 

The following is often found to be an exceedingly 
serviceable prescription in the condition of insomnia 



238 TYPHUS FEVER. 

and delirium, and is highly recommended by several 
authorities who claim for it magical effects, the 
patient waking refreshed and rational : 

9. Liq. opii sed. (Battley) . . 31. 

Antimon. et potass, tart. . . gr. i. 
Aquae camphorae . . . %vi. 

M. Sig. A dessertspoonful every hour, until 
sleep is induced. 

Regarding prophylaxis in the treatment of this 
disease, Dr. A. L. LOOMIS advises the strictest regu- 
lations of quarantine, disinfection, ventilation, and 
careful attention to cleanliness, etc. He directs that 
the patient be placed, if possible, in a large, airy 
room, free of all materials likely to retain infection, 
and an abundance of fresh air secured at all times ; 
this he considers a factor of the greatest importance, 
and believes that mild cases require very little else 
in the way of treatment. The diet also requires the 
most careful attention, as regards the selection of 
proper food, its administration, and the avoidance 
of all over-feeding. Force may even be necessary 
for the sustenance of the patient ; or the stomach 
tube passed through the nares, is often of great 
service for this purpose. Milk he considers the best 
food for these patients, given frequently and at 
regular intervals ; or milk with yolk of eggs may be 
used when desired. 



TYPHUS FEVER. 239 

For the reduction of the temperature, he places 
most reliance upon quinine, as a rule, although the 
cold bath is often used, particularly in the earlier 
stages of the disease where the exacerbations are 
more rapid. If necessary this is also assisted by a 
full dose of quinine, administered about twenty 
minutes after removal from the bath. Ice-bags to the 
head are found a serviceable adjunct to the bath, 
especially where there is much pain in the head, or 
if active delirium is present during its administration. 
After the first week, however, he usually finds that 
quinine alone is a sufficient antipyretic, particularly if 
the fever has previously been kept below 103 . 

Regarding the use of alcoholic stimulants, Dr. 
Loomis does not favor them in all cases, and es- 
pecially in young subjects. To control the pulse, 
however, and support the heart's action, stimulants 
are given as indicated and with much benefit. Where 
prostration is extreme, the judicious use of alcohol 
is, in many instances, followed by very satisfactory 
results. In other cases, where frequency of the 
pulse, occurring in the early stage of the disease, is 
due to a failing heart, digitalis is given and often 
with excellent effect ; as follows : 

Ijfc. Infus. digitalis . . . 3 ii— iv. 
Sig. This amount in twenty-four hours. 

For the intense pains in the head, cold in the 



240 TYPHUS FEVER. 

shape of ice-bags renders marked service ; or when 
associated with photophobia, a small blister applied 
to the back of the neck, is found very efficacious. 
The insomnia which is frequently present is also 
usually relieved by the use of cold applied to the 
head ; if it persists, however, in spite of this measure, 
opium is given to control it. When other marked 
nervous phenomena are also present, he finds the 
careful administration of chloral hydrate very bene- 
ficial. If stupor is marked, this is met by the local 
resort to stimulating applications, combined with the 
internal use of the diffusible stimulants ; of which he 
prefers musk and camphor, or in some instances 
coffee. 

During convalescence, Dr. Loomis advises great 
care in avoiding all over exertion, exposure, etc. 
The appetite must also be held within bounds. At 
this time, tonics, iron and quinine, and the mineral 
acids are often of service, especially if there is feeble 
heart action. For this purpose, the following, one 
of Dr. Loomis' favorite tonic formulas, may be found 
of marked benefit : 

9- Sol. quiniae sulph. (gr. xv- f i.) . J ii. 

Tinct. ferri chlor. . . § ss. 

Spts. chloroformi . . . 3 vi. 

Glycerinse q. s. ad . . § iv. 

M. 



OTITIS. 241 

OTITIS. 

(EAR-ACHE.) 



For the pain, which Dr. O. D. Pomeroy believes 
should receive primary consideration, he finds the ap- 
plication of one or two leeches to the part, the best 
plan of treatment. If, as occasionally happens, the 
leech aggravates the pain, morphia is cautiously 
used, which acts as a true anti-phlogistic as well as 
anodyne. He then repeats the bleeding, if necessary, 
so long as the pain or sensation of fullness con- 
tinues ; care being taken, however, not to produce 
exhaustion. In many cases, he advises, milder 
measures suffice ; such as the application of dry heat, 
by means of a rubber bag, or a bottle, of hot water, 
the temperature being adjusted to the comfort of the 
patient. Water either too hot or too cold, he finds, 
will only serve to increase the pain. Hot salt bags 
are also used very effectually, or sometimes a roasted 
onion acts well. Regarding moist applications, in 
his experience although they afford relief, yet, if 
continued too long, otorrhcea and other serious re- 
sults may follow. A little paregoric on cotton is 
also serviceable, or at times morphia is cautiously 
employed. In other cases, he finds that a bit of cot- 
16 



242 OTITIS. 

ton with black pepper wrapped in it, will warm the 
parts and allay the pain. (This should first be tried 
on an adult, so as to avoid excessive burning.) The 
following is also regarded by him as very efficacious : 

9- Atropiae sulph. . . . gr. iv. 
Aquae gi. 

M. Sig. To be dropped into the eye. 

Steam, or the vapor of chloroform, blown into the 
ear, are also employed with good result. 

Regarding puncturing of the membrane, if there is 
a collection of the secretions in the tympanum, Dr. 
POMEROY considers this operation more appropriate 
for the relief of pain, than leeching. Where no dis- 
charge follows the puncture, he then resorts to in- 
flation ; and by inclining the head to the affected side, 
all the discharge may in this way be blown out. This 
is repeated every day or two until the accumulation 
has finally ceased. After the pain is relieved, he di- 
rects that cotton be kept in the ear, removing it as 
often as it becomes moistened. The ear is also 
kept clean by injections and syringing, very gently 
(so as not to cause a return of the throbbing 
pain), with a warm saline solution (3 i-Oi.), and care- 
fully wiped out and dried once or twice daily. 
After two or three days he inflates the drum, and 
if the discharge does not diminish in from four to 
six days, he then resorts to astringents. For this 



OTITIS. 243 

purpose the following is often preferred by 
him : 

9- Plumbi acetat. gr. ii-v. 

Aquae § i. 

M. To be poured into the ear twice daily, after 
syringing. 

Or, sometimes argenti nitrat. of the same strength 
is used. If a disinfectant is needed, the following 
may be employed instead of the above : 

9. Acidi carbolici . . . . 3 i. 
Aquae %xvi. 

M. 

But, in any case, he advises that whatever astrin- 
gent be used, none should cause excessive pain or 
make the ear throb afterward. 

This plan of treatment Dr. Pomeroy usually finds 
quite successful. Where, however, the discharge 
does not disappear, he then fills the canal with boracic 
acid, finely powdered, well packed in by means of 
cotton (using a holder), and permits it to re- 
main until it becomes moistened by the dis- 
charge, when it is removed by syringing and again 
renewed. 

Dr. A. Jacobi finds that in many severe forms of 
ear-ache, where the trouble is probably caused by a 
catarrhal affection of the Eustachian tube, by closing 
the mouths of infants and children and simply blow- 



244 OTITIS. 

ing into the nose, is often a very valuable method of 
affording relief to the pain. 

Dr. R. F. Weir uses morphine and atropine very 
effectually to control the pain, together with injec- 
tions of hot water, that is to say, by pouring the 
water into the ear, not syringing it ; and in many 
instances this latter measure alone suffices, the child 
falling asleep during the procedure. Leeches he 
objects to. Regarding paracentesis, he finds that 
especially in children the external canal is often 
swollen and painful, thus rendering the operation 
difficult and impracticable ; hence, he advises that, 
as a rule, it is best to let the drum alone. 

Dr. A. A. SMITH is in the habit of using warm 
douches, together with the application of heat in the 
form of hot salt bags. In some cases, however, he 
finds it necessary to give a full dose of an anodyne. 
He has also obtained good results from blowing 
chloroform vapor into the ear. 

Dr. Beverly Robinson has derived benefit from 
the application of leeches, when all other means had 
failed. He also finds much relief afforded by the 
use of the continuous douche. In other instances, 
he has used salicylate of soda in large doses very 
successfully in allaying the pain. 

Dr. C. R. Agnew considers the warm douche and 
opium of the greatest value. 



OTITIS. 245 

In all cases, Dr. S. Sexton regards rest and quiet 
as very important in the treatment, confining the 
child to the house for several days, and if the case is 
a severe one, in bed. All active measures, he ad- 
vises, should be avoided, particularly inflation, and 
the patient cautioned against violently blowing the 
nose. For the immediate relief of pain, where the 
condition of the canal admits of deep applications 
being made, belladonna is found very serviceable. 
For this purpose, he paints the deeper parts over 
with a small quantity of the following: 

9. Ung. belladon. 

Olei-paraffini (Vaseline) . . aa §i. 

M. 

Or, sometimes the following is preferred : 

-5- Atropiae sulphat. . . gr. v. 

Aquae . . . . . , §i. 

M. Sig. Four drops, to be dropped in the ear. 

In using these, he advises that they should be first 
warmed, and the canal previously freed of secretions. 
Dry warmth, when grateful, is also applied with 
much benefit ; either as heated air from hot salt 
bags, or by means of heated pillows. In some in- 
stances this may be all that is required. He also 
finds that this measure accomplishes just as much as 
warm water, which, though often beneficial when 
poured directly upon the drum head, may prove in- 



246 OTITIS. 

jurious. Or, at times, gentle fomentations r>r steam- 
ing is employed, but all active syringing, douching, 
poulticing and the like, are particularly objected to ; 
indeed, he believes these measures often do positive 
harm. In the later stages, however, syringing and 
mopping is more thoroughly practiced, and occasion- 
ally the air douche is cautiously employed. Ano- 
dynes are seldom used by him with children ; more- 
over, he finds that large doses of narcotics only 
serve, sooner or later, to make the trouble worse. 

In regard to puncturing the membrane when no 
discharge occurs from the inflamed parts, Dr. Sex- 
TON advises that a resort to this procedure should 
receive the most careful judgment. In his experi- 
ence it is not always demanded for relief, even 
where the membrana tympani is much protruded by 
the accumulated secretions ; as he finds other means 
of treatment often efficient in causing the pain and 
inflammatory symptoms to speedily subside. When, 
however, there is considerable thickening and tough- 
ening from previous attacks, attended with closure 
of the Eustachian tube, he considers the operation 
justifiable ; and, when indicated, he directs that it be 
done promptly, under the influence of an anaes- 
thetic. 

The use of leeches he finds unsatisfactory, as the 
abstraction of blood from the adjacent part of the 



OTITIS. 247 

cheek, or even from the concha, does not relieve 
the deeper congestion. Moreover, besides the irri- 
tation from the bite, their appearance tends to 
frighten the child, and often it is difficult to check 
the bleeding. Blistering, and painting with iodine, 
he regards as too irritating in effect, and should be 
avoided. 

In cases of ear-ache associated with nervous ex- 
citement, he places most, reliance upon Pulsatilla, 
especially in very young children, giving it thus : 

9- Tinct. anemon. praten. . gtt. v-x. 
Aquae § iv-vi. 

M. Sig. A teaspoonful as necessary. 

He also uses aconite and gelsemium with great ef- 
ficacy. In either case, he advises the importance of 
obtaining a tincture from the fresh plant. 

Calcium snlphide is considered by him to be a 
most valuable remedy, and he rarely finds that any 
nausea is produced by its use.. In his opinion it 
both prevents and arrests suppuration, or it may 
limit the inflammation and hasten recovery. In these 
cases he usually gives the drug in pill form, but 
where this is impracticable, it may be administered 
in the form of a trituration ; thus : 

Ijfc. Calcii sulphidi . . . gr. \. 

Sacchari lactis . . . gr. ii-iii. 

M. Sig. Dose, every three or four hours. 



248 OPHTHALMIA. 

Finally, in all cases of ear affections, he particu- 
larly directs that an examination of the mouth and 
upper part of the pharynx should always be made, 
and any causes of irritation there present receive 
careful treatment ; e. g. caries and other disorders of 
the teeth and gums, naso-pharyngeal catarrh, etc. 



OPHTHALMIA. 



In simple catarrhal affections of the eye, Dr. C. 
R. AGNEW advises that it would be much better if 
the general practitioner should never resort either 
to the solid stick, or strong solutions, of silver nitrate, 
or the sulphate of copper. He also cautions against 
the use of poultices, his belief, in this respect, being 
formulated thus : " If you want to put the eye out, 
poultice it." In his experience the following is the 
most effectual treatment in these cases : 

Ipfc. Acidi tannici . . . . gr. x. 
Sodii biborat. gr. x. 

Glycerinae . . . . 3 i. 

Aquse camphorae ... § i. 

M. Sig. To be applied 'once daily, in form of the 
spray. 



OPHTHALMIA. 249 

For applying this, he uses a Davidson's atomizer, 
No. 55, thoroughly spraying the everted lids once 
daily. (After using this solution in an atomizer, it 
it will be necessary, each time, to wash the instru- 
ment out with water, in order to keep it in perfect 
working condition.) In addition to the spray, he 
directs that the eyes be bathed with a solution of 
salt in water, 3 i-Oi., the temperature of the water to 
be determined by the feelings of the patient. Or, 
in many instances, he employs the following with 
equally good results : 

5. Sodii biborat. . . . . 3 ii- 

Aquae camphorae . . . § vi. 

M. 

Of this, a tablespoonful is to be mixed with a 
tablespoonful of hot water, and used for bathing the 
eyelids from three to five times daily. In doing this, 
he advises the precaution of freshly mixing the solu- 
tion each time it is used ; otherwise, some patients 
are apt to continue with the same water over and 
over again. 

In all cases, Dr. AGNEW directs especial attention 
to diet, hygiene, and exercise. The prevalent habit 
of scant feeding must be corrected, and the food 
made of the most nutritious character, taken regularly 
and in gradually increasing amounts. These measures 
he considers of the highest practical importance. 



250 OPHTHALMIA. 

In the purulent ophthalmia of infants, Dr. J. 
Lewis Smith recommends the following with much 
satisfaction : 

9. Hydrarg. corros. chlor. . . gr. i. 
Aquae rosae . . . . § ii. 

Aquae %vi. 

M. Sig. Apply every three hours. 



PART VI. 
SKIN DISEASES. 



ECZEMA. 



In infantile eczema, Dr. L. Duncan Bulkley 
advises that too much dependence must not be 
placed on the local treatment of the disease, as he 
finds that evidences of imperfect assimilation can al- 
ways be discovered in these children. The evacua- 
tions from the bowels are faulty ; the urine con- 
stantly presents traces of mal-assimilation, and 
thorough investigation invariably shows an imperfect 
state of health. Moreover, in nursing children, he 
considers it of the highest importance that careful 
attention be paid to the mother, who very frequently 
exhibits dyspepsia or constipation, or is considerably 
debilitated ; or possibly is taking ale, beer, unnatural 
quantities of tea, etc. ; all of which disagree and 
cause trouble in the child. Therefore, if the in- 
fluence of internal, general, dietary, and hygienic 



252 ECZEMA. 

causes be strictly attended to, he finds that much 
less in the way of treatment is required locally; and 
what is thus used, is more rapidly and more com- 
pletely successful. But he also cautions that if these 
are not recognized and managed with care, the re- 
sults of local treatment are imperfect and uncertain. 

Internal medication, to a certain degree, he con- 
siders absolutely necessary. As a rule, he gives 
small purgative doses of calomel every other day, 
and a mild alkali, such as potassium acetate in the 
liquor ammoniae acetatis, with a little nitre, and per- 
haps aconite. Individual cases, however, require dif- 
ferent management. 

In regard to mechanical restraint to prevent the 
scratching, Dr. BULKLEY aims to relieve the itching 
by proper applications, and thus avoid resorting to 
such extreme measures. The diachylon ointment, 
employed by some, he considers very inefficient for 
this purpose in infantile cases. Tar in some form 
is much preferred, the following combination being 
a favorite with him : 

5-. Unguent, picis . . . § i. 

Zinci oxidi . . . . 3 "• 

Unguent, aquae rosae . . . § iii. 

M. 

This, he advises, should be carefully prepared, and 
very thoroughly and abundantly applied. If it ap- 



ECZEMA. 253 

pears stimulating, less of the tar ointment is used. 
He lays great stress on employing the rose ointment y 
and not simple cerate, or lard, or vaseline, or pe- 
troleum. He also directs that the ointment be made 
of a consistency to spread easily, and yet not to all 
melt away after application. Concerning the use of 
water to eczematous surfaces in children, he advises 
that they should be washed only as directed, and 
that very rarely ; often only at intervals of several 
days. Furthermore, in his experience, it is all im- 
portant that the protective ointment be replaced 
immediately after the surface is dried, and renewed 
sufficiently often to keep the parts completely 
shielded ; even twenty or more times during the first 
day. On covered parts, the ointment may be spread 
thickly on the wooly side of sheet lint, and bound 
on. As to the use of a mask for the face, he never 
resorts to this measure, and rarely finds it necessary 
to restrain the infant much after the first day or 
two. The only approach to this practiced by him, 
is putting on muslin mittens, tied about the wrist, 
and with tapes from these passing behind the back, 
or beneath one leg. Under this management, if 
every particular is carried out, he is assured of but 
one result, namely, arrest of the eruption and, if the 
dietetic and hygienic elements are also persisted 
in, a cure of the disease. 



254 ECZEMA. 

Regarding arsenic in the treatment of eczema, 
although not considered as a specific, yet he finds it 
of great service, on account of its effect in quieting 
nervous irritation. Indeed, in many instances, he 
has obtained almost instant relief from the internal 
administration of Fowler's solution alone. As a 
rule, in all cases, he gives arsenic internally at some 
stage of the disease. 

In eczema of the anus and genitals, not infre- 
quently met with in older children, and more 
particularly in chronic cases, Dr. Bulkley has 
derived great satisfaction from the following method 
of treatment. To correct the imperfect intestinal 
secretions and the imperfect liver action, which is 
usually an accompaniment of this condition, is, in his 
estimation, of primary importance. For this purpose 
he advises, the most careful judgment is often 
necessary ; purgatives and laxatives are not sufficient, 
nor does any routine plan answer for all. Generally, 
however, he finds the following prescription very 
useful : 

IjL Sulphur, praecipitat. 

Potass, bitart. . . . aa § i. 

M. Sig. A teaspoonful at night, rubbed up with 
sufficient water to make a paste. 

In addition, diet, hygiene, exercise, and regularity 
in attending to the calls of nature, are also required, 



ECZEMA. 255 

together with what internal medicinal assistance may 
be needed. If the disease is simply due to debility, 
he administers iron and other tonics with much 
benefit. Arsenic he seldom, if ever, employs as a 
curative measure at the beginning, in these cases, and 
especially not in acute forms. But in the later stages, 
and where there is marked eczematous habit, when, 
after all other means have been carefully attended to, 
there still remains a tendency to the disease, he then 
uses arsenic in connection with other remedies. 

Local treatment is also considered of vast impor- 
tance. He particularly cautions, however, that too 
strong applications are apt to do more harm than 
good, and directs that the soothing plan be followed 
as far as possible, especially where there are signs of 
inflammation present ; stimulating measures being 
resorted to only in the later stages. The itching, he 
finds, yields promptly to mild treatment, together 
with the proper general assistance. He places most 
reliance upon hot water (not merely warm) to relieve 
the congestion. To be of service, however, Dr. 
BULKLEY insists that the following plan must be 
strictly adhered to. He directs that the patient be 
made to sit upon the edge of a chair, having a basin 
of water at hand with a soft handkerchief in it. This 
latter is then to be held in a mass, as hot as can be 
borne, to the parts, for a minute at a time, and the 



256 ECZEMA. 

process repeated three times. Too long or too fre- 
quent bathing, or rubbing with a cloth, is injurious. 
Ordinarily, the hot water is applied only once in 
twenty-four hours ; usually immediately before retir- 
ing thus affording a quiet and generally sound sleep. 
All scratching, or even touching the part, must be 
carefully avoided if possible. Before applying the 
hot water, the ointment to be employed is prepared, 
thickly spread on lint, and cut of a size to cover the 
affected parts only. After these have been dried by 
soft pressure, but absolutely without friction, the 
already spread cloths are immediately applied, thus 
at once and entirely excluding the air. In severe 
cases the hot water is repeated occasionally, but 
usually he finds it sufficient to simply renew the 
ointment one or more times during the day. The 
ointment employed varies somewhat with the case ; 
as a rule, however, he prescribes the tar and zinc 
oxide ointment with ung. aquae rosse, already men- 
tioned. Vaseline, as a base, is objected to, as it 
soaks in too rapidly ; thus leaving the parts dry and 
exposed to the air Or, in other instances, the fol- 
lowing combination is used by him very effectually: 
IJ. Unguent, picis ... 3 iii- 

Unguent. bellad. ... 3 ii. 

Tinct. aconit. rad. * . . 3 ss. 

Zinci oxidi . . . * 3 i- 



ECZEMA. 257 

Unguent, aquae rosae. . . 3 iii. 
M. Ft. unguent. 

An ointment of chloral and camphor is also, in his 
experience, a very efficient anti-pruritic. This he 
formulates as follows : 
9- Chloral, hydrat. 

Camphorae ... aa 3 i — ii- 

Ung. aq. rosae . . . . 31. 

M. 

Or, in certain cases, he finds lotions sometimes 
very serviceable ; often prescribing the following : 
9- Bismuthi subnit. . . . 3 ii. 

Acid, hydrocyan. dil. . . . 3 i- 

Emuls. amygd. . . . § iv. 

M. Ft. lotio. 

This, he advises, should not be used where the 
skin is torn or broken. When stronger applications 
are necessary, as in cases where congestion has ceased, 
leaving some thickening and a tendency to the forma- 
tion of fissures, he uses the following with good effect. 
9. Saponis viridis 
Olei cadini 

Alcohol . . • . aa § i. 

M. 

This is rubbed briskly over the parts for a few 
minutes, and followed immediately afterward by a 
mild ointment, such as : 
17 



8 


ECZEMA. 




9- 


Zinci oxidi 


3ss. 




Ung. aquae rosae 


§i. 


M. 






Or: 






9- 


Bismuthi subnit. 


3ss. 



Ung. aq. rosae . . . . % i. 
M. 

Or, he sometimes substitutes calomel for either 
the zinc or the bismuth, with much satisfaction. Oc- 
casionally, however, Dr. Bulkley resorts to the ap- 
plication of caustic potash in solution, followed by 
soothing measures. When the fissures still persist, 
the solid stick of silver nitrate is, at times, employed ; 
after which the part is packed with cotton. But 
these ultimate means of relief, he advises, are to be 
used with caution, otherwise bad results may follow. 

In the treatment of infantile eczema, Dr. A. 
JACOBI advises that the addition of potassium to 
cow's milk is contraindicated, since it already con- 
tains too much in comparison with the breast milk. 
In his experience sodium should be added, rather 
than potassium. 

The use of water should also be avoided. In some 
instances he finds it necessary to employ physical 
restraint, to prevent the child from scratching. As 
a rule, also, a mask for the head and face generally 
proves very serviceable. In chronic cases, the first 



ECZEMA. 259 

indication is removal of the scab. For this purpose, 
he uses the following mixture very effectually : 

5- Liquor potassae . § i. 

Olei olivae .... § viii-x. 

M. Sig. To be applied from two to five times 
daily. 

Or cod liver oil is sometimes substituted for the 
olive oil. This application soon breaks up the crusts 
so that they can easily be removed. In mild cases, 
he often finds that oil, soap, or poultices will suffice. 
After their removal, the surface is kept dry with soft 
cloth, and a new formation of scab thus prevented. 
An ointment is then applied, of which Dr. JACOBI 
usually places most reliance upon the unguentum 
diachylon. For constitutional treatment, he admin- 
isters arsenic, and iron when indicated, with marked 
benefit. 

The following is the formula for the above oint- 
ment, as used at BELLEVUE HOSPITAL : 

9. Emplast. plumbi . . . J v. 

Olei olivae . . - . . § iv. 
Olei lavandulse ... 3 i. 

M. 

In infantile cases, if the child is still nursing, Dr. 
G. H. Fox directs that the time of feeding be regu- 
lated so that the breast is given only at stated 
periods ; beginning at first with intervals of one and 



260 ECZEMA. 

one-half hours, and working up gradually until three 
hours intervene between the nursings. In older 
children, he insists upon strict regulation of the 
diet, which is usually in a poor condition, confining 
the patient to meat, soups, milk with and without 
bread, oatmeal, eggs, etc. ; and stopping all tea, cof- 
fee, beer, spirit, candy, cakes, and the like, either at 
meals or between them. Plenty of exercise in the 
open air is also advised. 

For local treatment, he first loosens the crusts by 
soaking them with olive oil, and after their complete 
removal, he then applies ung. zinci oxidi, by spread- 
ing it thickly upon old linen and binding it upon the 
part. In cases of eczema capitis, he sometimes or- 
ders the use of the following with much benefit : 

]jjfc. Acidi boracici . . . 3 ii. 

Aquae §i. 

M. 

After washing the head thoroughly with the above 
solution, unguent, cadini Zz-%i- is applied. In 
other instances, where the discharge is very free and 
abundant, matting the hair together and forming 
thick scabs, after washing the crusts with oil and 
soap, and thoroughly removing them, he generally 
obtains excellent results by applying the following 
ointment : 

JL Iodoformi . . . . 3 ii. 



ECZEMA. 26l 

Ung. zinci oxidi ... § iii. 

M. 

Or, where the eruption covers a larger surface, as 
the entire face and occiput, he directs that a mask 
of white flannel be made, with holes for the eyes, 
nose, and mouth, and with this to retain in position 
the cloths spread with ointment. In such cases, also, 
the zinc oxide ointment is often used very success- 
fully. 

For internal medication, he frequently prescribes 
the following with good service : 

5. Potassii acetat gr. v. 

Aquae q. s. 

M. Sig. Dose, three times daily, to a child of 
one to two ye,ars. 

If the bowels are constipated, as is usually the 
case in infants, he administers calomel in doses of 
gr. ss. with much benefit. 

In the eczema of older children, even of long 
standing, Dr. FOX finds that as a rule, to which 
there are few exceptions, the disease responds readily 
to appropriate treatment ; and cases which have 
been considered as incurable, he frequently finds the 
easiest ones to cure. If seen in the first stage, 
when practicable, he directs that thin sheet rubber be 
applied to the part, or, where this cannot be pro- 
cured, oil-silk. By this means the surface exudation 



262 ECZEMA. 

is promoted, and the swelling and itching in a great 
measure relieved. His next object, as far as local 
treatment is concerned, is to soothe and protect the 
thin, tender, newly-formed epidermis (second stage), 
and to prevent a recurrence of the swelling, which 
would inevitably restore the moist condition of the 
eruption. This he accomplishes by the application, 
night and morning, of the ordinary zinc oxide oint- 
ment, spread on strips of cloth and secured with a 
muslin bandage ; a rubber bandage, he advises, which 
proves decidedly efficacious in the early period of 
the treatment, would now do more harm than good. 
In the third stage, he applies trie ointment of cade 
locally, and administers potassium acetate internally, 
with excellent effect ; or sometimes unguent, dia- 
chyli is used with best results. Or, where the scalp 
is involved, he often prefers the white precipitate ; 
thus: 

5-. Hydrarg. ammoniat. . . part. iv. 
Thymol .... parsi. 

Oleo-paraffini (vaseline) . . part. xlv. 

M. Ft. ung. 

In chronic cases, often with the dry, erythematous 
form of eczema present, where the general health is 
impaired, Dr. Fox advises that although the local 
means employed afford temporary relief, the erup- 
tion can only be permanently cured when the health 
of the patient has been in a marked degree restored. 



ECZEMA. 263 

He therefore resorts to the use of tonics, alkaline 
diuretics, etc., continued for some time. In these 
cases, also, instead of zinc oxide ointment alone, he 
frequently adds ten per cent, of cade. In chronic 
eczema of the scalp, he considers the following very 
desirable in many cases : 

5- Olei cadini %i. 

Olei amygd. dulc. ... § iii. 

M. 

The effect of local treatment, however, is apt to 
be very uncertain. 

Dr. W. H. Draper considers rest very important, 
especially where the itching is intolerable ; as the 
child is thus deprived of sleep at night, and the 
constitution becomes run down, preventing success- 
ful treatment. Therefore, by paying attention to 
this particular, he finds that surprisingly good results 
often obtain in a very short period. In these cases, 
as a rule, he places the child at once upon the use of 
opium, in some form, combined with the local appli- 
cation, on lint, of the following : 

Ij£. Zinci oxidi .... 

01. juniperi . . . . aa 3 i. 
Adipis 1'\. 

M. Ft. ung. 

Frequently, also, a neutral salt of potassium is 
given as a diuretic. 



264 ECZEMA. 

Dr. R. W. Taylor finds soothing applications, 
in the form of powders or lotions, such as lead and 
opium, most serviceable in the erythematous stage. 
As the disease increases in age, he resorts to stimu- 
lation in addition. This latter measure he believes 
to be one of the cardinal points in the treatment of 
eczema ; at the same time keeping the surface well 
protected, while gradually continuing with the use of 
the stimulant application. Zinc ointment alone, he 
advises, will not effect a cure unless something directly 
curative is added ; for this purpose he finds tar very 
serviceable. He also believes that, in most cases, 
strong solutions of potasJi can be employed with 
advantage, and will afford relief where soaps often 
fail. In using them, however, he cautions that their 
action must be controlled so as to get the effect of 
strong stimulation, and at the same time prevent 
any inflammation. 

For internal medication, in his experience arsenic 
very greatly assists the external treatment, through 
its power to stimulate the skin. Therefore, while 
he considers the golden rule to be to attend to the 
local measures, yet, in many cases, he finds the 
internal use of arsenic exceedingly beneficial. 

The following is constantly used at the NEW YORK 
Hospital : 

5. Ung. picis 3iv. 



HERPES. 265 

Zinci oxidi 3 i. 

Cerat. simplic § iss. 

M. Ft. unguent. 

Also the following, as an eczema drying salve : 

Ijfc. Plumbi glycerat 3 i. 

Ung. zinci oxidi . . . § i. 
M. 



HERPES. 



Dr. G. H. Fox directs attention to the general 
health, etc., administering tonics, iron, strychnia, and 
quinine, according to the indications present. Many 
cases of a mild character, as in herpes facise and 
labialis following a common cold, where the eruption 
is slight, he finds require little or nothing more in 
the way of treatment. The syrupi ferri iodidi is 
often prescribed very effectually. As a rule, how- 
ever, for local measures he aims to protect the delicate 
walls of the vesicles from rupture, by means of some 
dusting powder, such as pulv. amyli, lycopodium, 
or, what he frequently considers better, an ointment 
of zinc oxide and lycopodium, applied liberally and 
then covered with a bandage to prevent rubbing of 



266 HERPES. 

the clothing. If the vesicles have burst, leaving a 
raw surface, he finds powders still useful, or some- 
times a simple ointment is employed. Frequently 
he uses unguent, zinci oxidi, or some anodyne lotion 
containing opium, belladonna, and camphor ; or in 
certain cases the following acts very beneficially : 

5- Acidi carbolici . . . gr. xii-xv. 
Aquae .... § i. 

M. 

He also prescribes the following with excellent 
service ; 

9-. Morphiae . . . . . gr. x. 
Collodii flexile . . . § i. 

M. Sig. To be painted over the part. 

In zoster, if the child suffers much pain, and 
especially if the rest is much disturbed by it, Dr. 
Fox administers opium to relieve it. For the neu- 
ralgic pains, more particularly those remaining after 
the local lesion has healed, he considers Fowler s 
solution in doses of gtt. v. one of the best internal 
remedies. Where there is much mental worry, a 
sleeping draught containing potassium bromide and 
opium is generally administered. 

In zoster occurring in older children, if the pains 
are beyond endurance, Dr. W. H. Draper gives 
morphia to control them ; combined, in some cases, 
with counter-irritation. Quinine is also found ser- 



ERYSIPELAS. 267 

viceable in many instances. Or, 'belladonna locally 
applied, especially in combination with opium, he 
finds often affords relief. Where the pains continue, 
however, in spite of other means of treatment, the 
application of the thermo cautery along the spinal 
column is sometimes resorted to effectually. (This 
latter on the theory that the disease depends upon 
congestion or inflammation of the roots of the 
spinal nerves.) 



ERYSIPELAS. 



Dr. A. Jacobi sometimes employs the following 
treatment very satisfactorily : 

9- Acid, carbol gr. xii. 

Acid, oleic 3 ii. 

M. 

This is applied to the skin which is tolerably 
normal around the erysipelatous patch, being 
thoroughly rubbed in with the finger. Only a small 
quantity is used at a time, and the application 
repeated at frequent intervals of half an hour or an 
hour. 



268 ERYSIPELAS. 

Dr. V. P. GlBNEY highly recommends the follow- 
ing, in cases of recurring naso-facial erysipelas of stru- 
mous origin, frequently met with in these children : 

9-. Tinct. ferri chlor. . . . 3 ii — iii. 
Glycerinse .... § iss. 

Aquae . ' . . . * § iss. 

M. Sig. A teaspoonful every two hours. 

At Bellevue Hospital the use of the compound 
tincture of benzoin in the treatment of this disease,. is 
employed with good results. The affected parts are 
painted with the tincture once or twice daily. As 
an application to the face, sheet lint is recommended, 
dipped in hot lead and opium solution. Instead of 
poultices, in erysipelas of the extremities, oakum is 
used soaked in hot plumb, et opii and covered well 
with oil-silk. By this means the moisture of the 
limb is retained, and a soothing influence exerted 
over the part. 

At the Presbyterian Hospital the following 
method of treatment has been administered very 
successfully, in cases of erysipelas in older children. 
Tinct. ferri chloridi is given internally in large doses 
and repeated every hour for six hours, in conjunc- 
tion with quinine in full doses three times daily. 
Locally the application of liq. plumbi et opii is em- 
ployed. In many instances this plan is attended 
with favorable results. Where, however, there is 



ERYTHEMA. 269 

rapid extension of the redness, injections of carbolic 
acid are often practiced, as follows : 

9- Acidi carbolici . . . m. xxx. 
Alcohol .... 3ss. 

Aquae destill. ... § i. 

M. 

This is injected at the upper border of the redness 
and repeated as indicated. After the extension is 
under control and improving, these are discontinued 
and local applications of carbolic acid resorted to. 
The iron and quinine are also continued. By this 
plan of treatment success has followed, when other 
means have proven altogether useless. 



ERYTHEMA. 



In cases of erythema multiforme, Dr. L. D. 
BULKLEY finds the following mixture very potent in 
reducing the cutaneous congestion in this condition, 
and considers it a remarkably valuable combination : 

9. Magnes. sulph §i. 

Ferri sulph. . . . .31. 

Acid, sulph. dil. . . 3 ii. 



270 URTICARIA. 

Tinct. gentian § i. 

Aquae § iii. 

M. Sig. A teaspoonful to a tablespoonful accord- 
ing to age. 

In erythema nodosum, Dr. G. H. Fox often de- 
rives much benefit from placing the child on the in- 
ternal use of syrupi ferri iodidi gtt. v. three times 
daily, in conjunction with the local application of 
unguent, zinci oxidi. When indicated, tonics are 
also administered with good effect. The condition 
of the stomach and intestinal canal should also re- 
ceive careful attention, and any existing disorder 
corrected. 



URTICARIA. 



DR. L. D. Bulkley administers alkaline baths at 
frequent intervals, combined with the subsequent in- 
unction of carbolated cosmoline, as follows : 

I£. Acid, carbol gr. v. 

Cosmolinae . . . . §i. 

M. Ft. ung. 

With these measures, for internal medication, he 



URTICARIA. 271 

also prescribes the syrup of the hypophosphites of 
soda, lime, and iron. 

In chronic cases occurring in older children, where 
the general health is poor, Dr. G. H. Fox first 
places the child on the following : 

5- Potassii acetat. . . . gr. x. 

Aquae ..... q. s. 

M. Sig. Dose, three times daily, to a child of ten 
to twelve years. 

This is continued for about a week, after which he 
stops this drug and gives tinct. ferri chlor. gtt. x. 
three times daily. After continuing the iron for a 
few days, he then orders the following : • 

Ijfc. Sol. Fowlerii .... gtt. v. 
Tinct. ferri chlor. . . . gtt. x. 
Aquae ; q. s. 

M. Sig. Dose, thrice daily, after meals. 

In addition, a pill containing ^r. ^ of aloin is taken 
every morning and afternoon. He also directs the 
patient to remain out in the sun as much as possible, 
for a week or more. Under this treatment decided 
benefit follows. After a while, as improvement oc- 
curs, he changes the tincture of the chloride for the 
ferri et potass, tart, with good effect. 

Dr. A. A. Smith recommends sodii salicylat. gr. 
ii. every half-hour or hour, with much satisfaction in 
the treatment of urticaria. 



272 SCABIES. 

SCABIES. 

(ITCH.) 



Dr. W. H. Draper usually employs sulphur, 
either by the bath, fumigation, or, as a rule, in the 
form of an ointment. By this latter method, also, 
he finds that any eruption of acne, which sometimes 
appears when the sulphur bath is used, is avoided. 
He considers it very important, however, that the 
epidermis should first be softened, in order to render 
the application of the ointment successful. This is 
accomplished by means of the hot bath, the skin 
being well rubbed and dried, and an ointment then 
applied as follows : 

9. Sulphuris .... §iii. 

Potass, carb § i. 

Adipis 5 viii. 

■ M. 

The patient is afterward clothed in flannel and 
put to bed. It is also important, he advises, that 
the application of the ointment be made over the 
entire body, not simply to the hands, etc., otherwise 
the parasite migrates to other parts. The only por- 
tions of the body which can be spared are the face 
and neck, as these are rarely attacked. Sometimes a 



SCABIES. 273 

single application is sufficient, but he generally con- 
siders it a safer plan to repeat the process three or 
four times, when he finds this treatment usually 
attended with success. In some rare instances, how- 
ever, the disease fails to yield to the sulphur treat- 
ment. Where such is the case, this remedy is 
stopped, and a carbolic acid ointment applied, thus : 
9. Acid, carbol. cryst. ... § i. 

Cosmolinae .... §xx. ' 

Sig. Melt each separately and mix. 
This measure is often followed by a speedy sub- 
sidence of the disease. 

Dr. G. H. Fox finds the following of most excel- 
lent service in this affection : 
]J. Sulphur, praecip. 

Balsam, peruv .... 
Potass, iodidi . . . aa 3i. 

Cosmolinae .... 3vii. 
M. Ft. ung. 

Or, in some instances, he uses the following with 
good effect : 

5- Sulphur, loti .... 

Sapon. virid. . . . . aa 5 i- 

M. 

Dr. L. D. Bulkley considers sulphur almost a 
specific in this affection. He directs that the child 
be first washed thoroughly with yellow soap, and 
18 



274 PHTHIRIASIS. 

then have the following ointment applied constantly 
for two or three days and nights : 

9- Sulphuris 3 i- 

Styracis 3 ii. 

Ung. adipis . . . . § i. 

M. 

By this means, he has frequently succeeded in 
curing the disease in a very short time. 
. The following sulphur paste is extensively em- 
ployed at Bellevue Hospital : 

9. Sulphur, sublimat. . . . §i. 

Athens 3 iii. 

Glycerinae . . . . . §i. 

M. 



PHTHIRIASIS. 

(lousiness.) 



Dr. G. H. Fox places the greatest reliance upon 
local treatment. In the milder cases of phthiriasis 
capitis, he finds that a small quantity of white precip- 
itate ointment of full strength, rubbed, not in the 
scalp, but throughout the hair, will effect a cure in a 



PHTHIRIASIS. 275 

few days. When a more desirable preparation is 
required, he uses the following: 

Ijfc. Hydrarg. corros. chlor. . . gr. iv. 

Aquae rosae . . . § i. 

M. 

Or this may be made up with cologne water, or 
with alcohol, instead of rose water. Where, however, 
much laceration of the scalp is present, or any spots 
of eczema, the mercurial solution is, as a rule, unsafe. 
Another and very elegant prescription, which is 
highly favored by him in this affection, is the follow- 
ing: 

9. Hydrarg. corros. chlor. . . gr. iv. 
Thymol . . . gr. xvi. 

Alcohol |L 

01. amygdal. amar. . . gtt. v. 

M. 

The oil of bitter almond added to the solution, he 
finds, gives it a more pleasant fragrance, which is 
sometimes commendable. 

In chronic cases of long standing, he thinks there 
is scarcely any better and simpler plan of treatment, 
both for the destruction of the pediculi and the soft- 
ening and removal of the ovi from the hairs, than 
the application of kerosene oil, freely used. In em- 
ploying this remedy, he directs that the head be 
thoroughly rubbed with the oil, and at night covered 



276 TINEA FAVOSA. 

with an oil-skin cap. In the morning the parts should 
be well washed with soap and water. In many of 
these neglected cases, he often finds severe forms of 
eczema capitis present, due to the irritation caused 
by these parasites. For this an ointment of zinc 
oxide is also applied, together with careful attention 
to diet, etc. 

In regard to the necessity of cutting off the hair, 
when long, Dr. Fox does not consider it absolutely 
essential, provided pains are taken to keep it clean 
and well dressed. Where, however, the hair is 
allowed to become matted through filth and neglect, 
he believes that the shears play an important part in 
the treatment. This latter, he advises, applies not 
only to this, but also to other affections of the 
scalp. 



TINEA FAVOSA. 

(favus.) 



Dr. L. D. BULKLEY considers depilation quite 
essential in the treatment of this disease, a view not 
held by all. 



TINEA FAVOSA, 277 

For this purpose the following method is a favorite 
with him : 

Ijfc . Cerae flavse .... 3 iii. 

Laccae intabulis . . . 3 iv. 

Resinae 3 vi. 

Picis Burgundicae . . . 3 x. 

Gummi dammar. ... 3 xii. 
M. 

This is made into sticks of various sizes. In using 
it, the end is heated until soft and then applied to 
the diseased scalp, the hair having been cut short. 
As soon as the wax becomes cool it is carefully 
withdrawn, bringing away the diseased hairs. He then 
uses the following wash with advantage : 

5- Hydrarg. bichloridi . . . gr. iv. 

Aquae § i. 

M. 

Regarding this measure, depilation, he directs at- 
tention to the fact, that many chronic cases are due 
to the error of supposing the disease is in a fair way to 
recovery, when there are no longer any crusts to be 
seen. He therefore advises that it is unsafe to dis- 
miss a patient, until every hair that has been, or is 
liable to be, affected has been epilated. 



278 TINEA TONSURANS. 



TINEA TONSURANS. 
(ringworm.) 



Dr. G. H. Fox highly recommends the following, 
as of the greatest efficacy in many of these cases : 
IpL Acid, carbol. gr. xlviii. 

Glycerinae 3 h\ 

Alcohol ..... 
Ol. cadini . . . . aa 3 iii. 

Ol. citronellae . . . . q. s. 
M. 

Chrysophanic acid is considered most efficacious 
by many ; or, in exceptional cases, combined with car- 
bolic acid. In young children, however, it must be 
used with caution, if at all. The following is the 
formula used at Bellevue Hospital: 

Tjfc. Acidi chrysophanici . . . gr. xx. 
Oleo-paraffini . . ' . 3 iii. gr. x. 
Sig. Melt the vaseline, and while hot add the 
acid, stirring till dissolved. fc 

Or, tincture of iodine, painted on once or twice 
daily and followed by the use of white precipitate 
ointment, is often found to be sufficient. Tonics are 
also valuable in many cases, especially cod liver oil, 



ALOPECIA AREATA. 279 

together with iron, etc. Sometimes the unguentum 
picis liquidum is of excellent service. This is com- 
bined at Bellevue Hospital, as follows : 

5. Picis liquidae . . . . 3*- 

Potassae 3ss. 

Aquae fervent, q. s. ad . . § i. 

M. Et add. 

Cerati § viii. 



ALOPECIA AREATA. 

(TINEA DECALVANS.) 



In many instances Dr. G. H. Fox finds the fol- 
lowing plan of treatment very successful. He orders 
a five per cent, oleate of mercury to be rubbed into the 
scalp night and morning. Small doses of calomel 
are also given internally, as a laxative. After con- 
tinuing this for two or three weeks, should no ma- 
terial benefit be derived, he substitutes liquor am- 
nion, fort, for the oleate, as an application to the 
scalp, and, if indicated, administers cod liver oil with 
good effect. Or, in certain cases, where a stimula- 
ting wash is desired, the following is recommended by 
him : 



280 ALOPECIA AREATA. 

9« Tinct. capsici .... %m. 
Tinct. cantharidis . . ^,'n. 

Aquae rosae * . . . . §v. 
M. Ft. lotio.' 

In others, where the general health is poor, he fre- 
quently prescribes : 

9- Tinct. ferri chloridi . . gtt. x. 

Sol. Fowlerii .... gtt. v. 
M. Sig. Dose, three times daily, to a child of 
eight to ten years. 

This is continued for a week or so, according to 
indications. He then often finds the following very 
satisfactory : 

jpfc. Sapon. viridis . . . . 3 i. 

Spts. vini rect § i. 

M. Sig. Use as a wash. 

Also, in numerous instances, he gives small doses 
of ext. jaborandi fl. with great advantage. As im- 
provement takes place, this is then continued in 
diminished doses for a short time afterward, with 
benefit. Or, sometimes he uses pyrogallic acid with 
very gratifying effect ; thus : 

]J. Acidi pyrogall 3 iii. 

Glycerinae 3i. 

Aquae 5 "• 

M. Ft. lotio. 



PSORIASIS. 28l 



PSORIASIS. 



In many of these cases, Dr. G. H. Fox first directs 
his treatment to the general health of the patient. 
If there is any stomach and intestinal disorder 
present, this is corrected by the administration of 
bismuth subnitrate and rhei et sodcz. After a better 
condition is attained in this direction, where the child 
is anaemic and with poor appetite, he then finds that 
a marked degree of improvement takes place under 
the administration of iron and cod liver oil. He 
gives : 

9- Syrupi ferri iodidi . . . 3 iv. 

Olei morrhuae .... § iiiss. 

M. Sig. A teaspoonful three times daily, to a 
child of six to ten years. 

In conjunction with this he often derives benefit 
from the application of unguent, hydrarg. ammoniat. 
Or, where the lesions are very extensive he some- 
times applies acid, chrysophanic. pur. covered with 
collodion, on certain portions, and on the rest ol. 
cajeput. This is continued as necessary, and is 
generally attended with success. Combined with this 
treatment, the internal use of arsenic is frequently 
prescribed by him with much service ; thus : 



282 PITYRIASIS. 

Ijfc. Liq. potass, arsenit. . . . 3 ii. 
Aquae cinnam. ... 5 llss ' 

M. Sig. Half a teaspoonful three times daily. 

Or, at times, the following is preferred : 

9. Sol. Fowlerii . . . . 3 ii. 

Tinct. cinchonae co. • ' • . 5 m - 

M. Sig. A teaspoonful thrice daily, to a child of 
eight to ten years. 

By these means of treatment the results are 
usually very favorable. 



PITYRIASIS. 



In pityriasis capitis, Dr. G. H. Fox sometimes 
directs that the patient be given a hot bath every 
night, and during this procedure to use as a shampoo 
to the head and body equal parts of sapo viride and 
alcohol ; and upon leaving. the bath, to rub vaseline 
into the affected parts. In certain cases, where an 
elegant application is desired, the following is highly 
recommended by him : 

9. Chloralis 3 iv. 

Glycerinae 3 i. 



PURPURA HEMORRHAGICA. 283 

Spiritus myrcise . . . 3 x. 

Aquae . . . . . §v. 

M. Ft. lotio. 

In pityriasis versicolor, he finds the following very 
effectual : 

5- Sulphuris 3 ii. 

Sapon. viridis .... 3 hi. 

Glycerinse . ... 3 ss. 

M. Ft. ung. 



PURPURA HEMORRHAGICA. 

(morbus maculosus.) 



Dr. A. Jacobi directs attention to this condition 
occurring in childhood, as generally arising from a 
defective development, from an abnormal state of 
the bloodvessels ; often associated with a large 
fatty liver, with a luxuriant growth of the adipose 
tissue of the body, and not infrequently with fatty 
degeneration of the heart. One of the chief ele- 
ments of his treatment is to prevent relapses of the 
hemorrhages, by careful attention to dietetic and 
hygienic regulations. He advises that the patient 



284 PURPURA HEMORRHAGICA. 

should have three or four hours leisure daily, com- 
bined with exercise out of doors, e. g. The child 
should be out in the open air for two or three hours, 
walk about three miles a day, and have a cold bath, 
or cold sponging, every morning. Regarding diet, 
he directs that all fatty and fat producing foods, 
such as fat itself, sugars, starches, etc., be rigidly 
avoided, and the patient fed with meat and milk in 
abundance, and with but a moderate amount of 
vegetable diet. As for medication, he derives much 
benefit from placing the child on the syrup of the 
iodide of iron. In some cases, the tendency to 
hemorrhage may be lessened by the administration 
of ergot ; but where there has been no tendency to 
dangerous hemorrhages, he does not consider this 
necessary. He also administers dilute sulphuric acid 
as a direct tonic to the blood vessels ; cautioning, 
however, against a too long continuance of its use, 
as after a time it tends to disintegrate the red blood 
corpuscles. Of this, he usually gives 3 ss. in the 
course of twenty-four hours, to a child of ten to 
fourteen years. In addition to these measures, in 
many instances, he also prescribes quinice sulphat. in 
doses of or. ii-iii. three times daily, with excellent 
effect. 



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